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Plata CA, Saldarriaga C, Echeverría LE, Sandoval-Luna JA, Llamas A, Moreno-Silgado GA, Vanegas-Eljach J, Murillo-Benítez NE, Gómez-Palau R, Arias-Barrera CA, Mendoza-Beltrán F, Hoyos-Ballesteros DH, Ortega-Madariaga JC, Rivera-Toquica A, Gómez-Mesa JE. Health insurance and clinical outcomes in patients with chronic heart failure in Latin America: an observational study of the Colombian Heart Failure Registry (RECOLFACA). Heart Vessels 2024:10.1007/s00380-024-02456-9. [PMID: 39264429 DOI: 10.1007/s00380-024-02456-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 09/04/2024] [Indexed: 09/13/2024]
Abstract
The effect of the health insurance type on the prognosis of heart failure (HF) patients in Colombia and Latin America is poorly known. We aimed to analyze the characteristics of HF patients that participated in the Colombian Heart Failure Registry (RECOLFACA) as stated by their health insurance type and their relationship with the immediate prognosis of these patients. Patients with HF diagnosis were included in the RECOLFACA registry between 2017-2019. The registry was conducted in 60 centers in Colombia. All-cause mortality was the principal outcome. To evaluate the impact of health insurance on mortality, a Cox proportional hazards regression model was used. The Kaplan-Meier analysis was performed to compare survival probabilities according to insurance type. All statistical analyses were two-tailed and were considered significant with a p value < 0.05. Of the 2,528 participants enrolled in the registry, 99% held details about their health insurance. Of those, 897 patients (35.6%) were covered by public insurance. These patients were significantly younger, with a lower proportion of men, more frequently from rural origin, and lower prevalence of most comorbidities (omitting hypertension, chronic obstructive pulmonary disease (COPD), and Chagas disease) than those with private insurance. Furthermore, patients with public insurance had a worse functional class, as well as a poorer quality of life, and lower frequency of use of implantable devices, while exhibiting similar prescription rates of triple medical therapy for HF. Finally, no differences in short-term mortality were observed between the two groups (HR 1.09; 95% CI 0.79, 1.51). The type of health insurance represents a condition related with relevant differences in the profile of patients with HF in Colombia. Despite this, no significant differences were detected in the short-term prognosis of these patients based on the type of health insurance.
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Affiliation(s)
| | | | | | | | - Alexis Llamas
- Department of Cardiology, Clínica Las Américas, Medellín, Colombia
| | | | | | | | | | | | | | | | | | - Alex Rivera-Toquica
- Department of Cardiology, Centro Médico Para El Corazón, Pereira, Colombia
- Department of Cardiology, Clínica los Rosales, Pereira, Colombia
- Department of Cardiology, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Juan Esteban Gómez-Mesa
- Department of Cardiology, Fundación Valle del Lili, Cali, Colombia.
- Department of Health Sciences, Universidad Icesi, Cali, Colombia.
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Oudin A, Raza W, Flanagan E, Segersson D, Jalava P, Kanninen KM, Rönkkö T, Giugno R, Sandström T, Muala A, Topinka J, Sommar J. Exposure to source-specific air pollution in residential areas and its association with dementia incidence: a cohort study in Northern Sweden. Sci Rep 2024; 14:15521. [PMID: 38969679 PMCID: PMC11226641 DOI: 10.1038/s41598-024-66166-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 06/27/2024] [Indexed: 07/07/2024] Open
Abstract
The aim of this study was to investigate the relationship between source-specific ambient particulate air pollution concentrations and the incidence of dementia. The study encompassed 70,057 participants from the Västerbotten intervention program cohort in Northern Sweden with a median age of 40 years at baseline. High-resolution dispersion models were employed to estimate source-specific particulate matter (PM) concentrations, such as PM10 and PM2.5 from traffic, exhaust, and biomass (mainly wood) burning, at the residential addresses of each participant. Cox regression models, adjusted for potential confounding factors, were used for the assessment. Over 884,847 person-years of follow-up, 409 incident dementia cases, identified through national registers, were observed. The study population's average exposure to annual mean total PM10 and PM2.5 lag 1-5 years was 9.50 µg/m3 and 5.61 µg/m3, respectively. Increased risks were identified for PM10-Traffic (35% [95% CI 0-82%]) and PM2.5-Exhaust (33% [95% CI - 2 to 79%]) in the second exposure tertile for lag 1-5 years, although no such risks were observed in the third tertile. Interestingly, a negative association was observed between PM2.5-Wood burning and the risk of dementia. In summary, this register-based study did not conclusively establish a strong association between air pollution exposure and the incidence of dementia. While some evidence indicated elevated risks for PM10-Traffic and PM2.5-Exhaust, and conversely, a negative association for PM2.5-Wood burning, no clear exposure-response relationships were evident.
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Affiliation(s)
- Anna Oudin
- Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umeå, Sweden.
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
| | - Wasif Raza
- Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umeå, Sweden
| | - Erin Flanagan
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - David Segersson
- Swedish Meteorological and Hydrological Institute, Norrköping, Sweden
| | - Pasi Jalava
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Katja M Kanninen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Topi Rönkkö
- Aerosol Physics Laboratory, Physics Unit, Tampere University, Tampere, Finland
| | - Rosalba Giugno
- Computer Science Department, University of Verona, Verona, Italy
| | - Thomas Sandström
- Division of Medicine/Respiratory Medicine, Department of Toxicology and Molecular Epidemiology, Umeå University, Umeå, Sweden
| | - Ala Muala
- Division of Medicine/Respiratory Medicine, Department of Toxicology and Molecular Epidemiology, Umeå University, Umeå, Sweden
| | - Jan Topinka
- Department of Genetic Toxicology and Epigenetics, Institute of Experimental Medicine of the CAS, Prague, Czech Republic
| | - Johan Sommar
- Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umeå, Sweden
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Sanz-Garcia FJ, Quesada JA, Carratala-Munuera C, Orozco-Beltrán D, Gil-Guillén VF, Prieto-Castello MJ, Marhuenda-Amorós D, Micó Pérez RM, Navarro Cremades F, Cordero A, Bertomeu-Gonzalez V, Arrarte V. [Predictive validity of the risk SCORE model in a Mediterranean population with arterial hypertension]. Med Clin (Barc) 2024; 162:112-117. [PMID: 37925274 DOI: 10.1016/j.medcli.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/10/2023] [Accepted: 09/13/2023] [Indexed: 11/06/2023]
Abstract
INTRODUCTION AND OBJECTIVES Hypertension is the most prevalent risk factor globally. Calculation of cardiovascular risk in hypertensive patients before initiation of treatment is recommended. This study aimed to assess the predictive value and clinical utility of the SCORE scale in preventing cardiovascular events and all-cause mortality in patients with hypertension. METHODS Patients with hypertension from the ESCARVAL-RISK cohort were included. Cardiovascular risk was calculated using the SCORE scale. All deaths and cardiovascular events were recorded during a 5-year follow-up period. Sensitivity, specificity and predictive values were calculated for different cut-off points and the effect of different risk factors on the diagnostic accuracy of SCORE charts were assessed. RESULTS In a final cohort of 9834 patients, there were 555 cardiovascular events and 69 deaths. The recommended risk value for initiating drug treatment (5%) had a specificity of 92% for death and 91% for cardiovascular events, and a sensitivity of 20% for death and 22% for cardiovascular events. In addition, the scale classified 80.4% of patients who experienced a cardiovascular event and 78.3% of those who died as low risk. Age, body mass index, retinopathy and anticoagulant therapy were associated with reduced predictive ability of the SCORE scale, while being female was associated with better risk prediction. CONCLUSIONS The predictive ability of the SCORE scale for cardiovascular disease and total mortality in patients with hypertension is limited.
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Affiliation(s)
- Francisco J Sanz-Garcia
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Campus de San Juan, Alicante, España; Centro de Salud Muro de Alcoy, Muro d'Alcoi, Alicante, España
| | - José A Quesada
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Campus de San Juan, Alicante, España
| | | | - Domingo Orozco-Beltrán
- Cátedra de Medicina de Familia, Departamento de Medicina Clínica, Universidad Miguel Hernández, Campus de San Juan, Alicante, España
| | - Vicente F Gil-Guillén
- Cátedra de Medicina de Familia, Departamento de Medicina Clínica, Universidad Miguel Hernández, Campus de San Juan, Alicante, España
| | - María J Prieto-Castello
- Departamento de Patología y Cirugía, Universidad Miguel Hernández, Campus de San Juan, Alicante, España
| | - Dolores Marhuenda-Amorós
- Departamento de Patología y Cirugía, Universidad Miguel Hernández, Campus de San Juan, Alicante, España
| | - Rafael M Micó Pérez
- Cátedra de cronicidad SEMERGEN-UMH, Departamento de Medicina Clínica, Universidad Miguel Hernández, Campus de San Juan, Alicante, España
| | - Felipe Navarro Cremades
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Campus de San Juan, Alicante, España; Cátedra de cronicidad SEMERGEN-UMH, Departamento de Medicina Clínica, Universidad Miguel Hernández, Campus de San Juan, Alicante, España
| | - Alberto Cordero
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Campus de San Juan, Alicante, España; Servicio de Cardiología, Hospital Universitario de San Juan, Sant Joan d'Alacant, Alicante, España
| | - Vicente Bertomeu-Gonzalez
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Campus de San Juan, Alicante, España; Servicio de Cardiología, Hospital Clínica Benidorm, Benidorm, Alicante, España.
| | - Vicente Arrarte
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Campus de San Juan, Alicante, España; Servicio de Cardiología, Hospital General de Alicante Dr. Balmis, Alicante, España
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Berdeshova G, Musina A, Orakbay L, Tolegenova A, Zhorabek S, Amanova A, Kulbayeva S. Trend of Cardiovascular Diseases in the Northern Regions of the Republic of Kazakhstan at the Outpatient Level. IRANIAN JOURNAL OF PUBLIC HEALTH 2024; 53:425-432. [PMID: 38894837 PMCID: PMC11182485 DOI: 10.18502/ijph.v53i2.14927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/16/2023] [Indexed: 06/21/2024]
Abstract
Background We aimed to study the rate and trends of the incidence of chronic cardiovascular diseases in urban and rural areas of the northern regions of the Republic of Kazakhstan (RK) from 2015 to 2020. Methods The retrospective data were analyzed using modern methods of biomedical statistics. We used the Electronic Register of Dispensary Patients (2015-2020), where we conducted a retrospective study and trend calculations. The study included patients with chronic cardiovascular diseases (CVD) (according to the International Classifier of Diseases-10, the following nosologies were identified: I25 chronic coronary heart disease and its nosological forms (I25.0-I25.9), and patients by age categories, consisting of dispensary registration in poly-clinics of the northern region of the RK. Results For 2015 - 2020 in the northern region (urban and rural) of RK, 12,315 patients were registered, who were on dispensary records for the chronic CVD. This amounted to 87.3% of urban residents, and 12.7% of rural residents. The share of patients with chronic CVD in the northern region of the republic by age groups had a bimodal growth pattern with the first peak at the age of 60-74 (40.4%) and the second - at the age of 45-59 (37.7%). Conclusion This study notes an increase in chronic CVD, both in urban and rural areas of the northern region of the RK. This once again proves the need for the development, implementation and use of modern tools in the provision of medical services to cardiological patients at the outpatient level, taking into account the characteristics of the northern regions of our country.
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Affiliation(s)
- Gulshara Berdeshova
- Department of General Hygiene, West Kazakhstan Medical University named after M. Ospanov, Aktobe, Kazakhstan
| | - Aiman Musina
- Department of Public Health and Epidemiology, Astana Medical University, Nur-Sultan, Kazakhstan
| | - Lyazat Orakbay
- Department of Public Health, Kazakh-Russian Medical University, Almaty, Kazakhstan
| | - Aidana Tolegenova
- Department of Health Policy and Management, Kazakh National Medical University named after S.D. Asfendiyarov, Almaty, Kazakhstan
| | - Saya Zhorabek
- Department of Health Policy and Management, Kazakh National Medical University named after S.D. Asfendiyarov, Almaty, Kazakhstan
| | - Assel Amanova
- Department of Public Health and Hygiene, Astana Medical University, Nur-Sultan, Kazakhstan
| | - Shynar Kulbayeva
- Department of Clinical Disciplines, Kokshetau University named after Sh. Ualikhanov, Kokshetau, Kazakhstan
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García-Mayor J, Moreno-Llamas A, De La Cruz Sánchez E. A decade beyond the economic recession: A study of health-related lifestyles in urban and rural Spain (2006-2017). Nurs Health Sci 2023; 25:700-711. [PMID: 37937892 DOI: 10.1111/nhs.13063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 10/09/2023] [Accepted: 10/19/2023] [Indexed: 11/09/2023]
Abstract
The 2008 economic recession may have affected health-related indicators differently depending on the living environment. We analyze health-related indicators in Spain using data from four Spanish health surveys (2006, 2011, 2014, and 2017, 95 924 individuals aged ≥16 years). In 2006-2011, physical activity decreased among men and women, while in 2006-2017, physical activity only decreased among urban women. Daily vegetable intake, except in rural women, increased in 2006-2011 but decreased in 2006-2017 in all groups. Smoking decreased among urban women in 2006-2011 and 2006-2014 but only decreased among men, and even increased among rural women, in 2006-2017. In 2006-2017, obesity increased among men and urban women, good self-rated health status increased in all groups and flu vaccination declined. Blood pressure and cholesterol control decreased in urban women in 2006-2011 but increased in 2006-2017 in all groups, as well as mammographic and cytological control. Our findings highlight the differential impact of the economic recession on health-related lifestyles according to sex and place of residence, underscoring the need for targeted health policies to address evolving health disparities over time.
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Affiliation(s)
- Jesús García-Mayor
- Public Health and Epidemiology Research Group, San Javier Campus, University of Murcia, San Javier, Spain
| | - Antonio Moreno-Llamas
- Public Health and Epidemiology Research Group, San Javier Campus, University of Murcia, San Javier, Spain
| | - Ernesto De La Cruz Sánchez
- Public Health and Epidemiology Research Group, San Javier Campus, University of Murcia, San Javier, Spain
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Murata S, Meyer AC, Ebeling M, Modig K. Centenarians: who are they? A description of the total Swedish centenarian population in terms of living arrangements, health, and care utilization. Aging Clin Exp Res 2023; 35:2759-2767. [PMID: 37668844 PMCID: PMC10628024 DOI: 10.1007/s40520-023-02555-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/27/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND The global centenarian population has doubled each decade and is expected to continue growing. However, information regarding how they live, their health status, and care needs is limited. AIMS This study aims to describe the total Swedish centenarian population in terms of health status, living arrangements, and socio-demographic characteristics. METHODS This nationwide register-based study included all Swedish people reaching age 100 between 2013 and 2018. We analyzed their socio-demographic characteristics, living arrangements, number of prescribed drugs, and health status. Moreover, their care transitions from age 100 and two years forward were described. RESULTS Of 5,882 centenarians (80.7% women), only 15.0% lived at home without formal care and 24.5% cohabited on their 100th birthday. Men (22.7%) were more likely than women (13.2%) to live at home without care. Approximately half of the centenarians lived in care homes, with fewer men (41.0%) than women (54.0%). Around 66.6% had a child living within the 50 km range. Most (76.5%) had an income below the median for Swedish older adults. Almost none were free from drugs, and polypharmacy was common (65.3%). Over half had at least one morbidity. Two years later, only 4.3% lived at home without care, and 63.9% died. CONCLUSION Sweden's centenarian population is highly dependent on home care and care homes. Among the ones still living at home, the vast majority live alone and have low incomes. Strategies to manage health and social care demands of this growing population group in the coming decade are important.
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Affiliation(s)
- Shunsuke Murata
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Box 210, 17177, Stockholm, Sweden.
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Anna C Meyer
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Box 210, 17177, Stockholm, Sweden
| | - Marcus Ebeling
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Box 210, 17177, Stockholm, Sweden
- Laboratory of Population Health, Max Planck Institute for Demographic Research, Rostock, Germany
| | - Karin Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Box 210, 17177, Stockholm, Sweden
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Murkamilov IT, Aitbaev KA, Fomin VV. [Prevalence, age and gender features of chronic kidney disease in patients with diabetes mellitus]. TERAPEVT ARKH 2023; 95:481-486. [PMID: 38158967 DOI: 10.26442/00403660.2023.06.202242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/14/2023] [Indexed: 01/03/2024]
Abstract
AIM To study the prevalence, age and gender characteristics of chronic kidney disease (CKD) in patients with diabetes mellitus (DM). MATERIALS AND METHODS In a case-control study, clinical and laboratory data were analyzed in 683 patients with DM (4.6% of patients with type 1 DM and 95.4% with type 2 DM) and kidney damage. The indicators of anthropometry, hemodynamics and biochemistry were studied. The glomerular filtration rate (GFR) was calculated using the CKD-EPI formula. RESULTS The proportion of middle-aged and elderly patients with CKD was the most numerous, amounting to 39 and 38%, respectively. At the same time, anemia was more common in young people, and hypercholesterolemia (35.0%), proteinuria (47.5%) and signs of renal failure (45.0%) - in middle-aged patients with CKD. 47.0% study participants had C1 and C2 categories of changes in renal function. Mean levels of systolic blood pressure (BP), the prevalence of proteinuria were statistically significantly higher in women. When evaluating the correlations, we found statistically significant relationships between the calculated GFR and the level of body mass index, systolic BP, venous blood glucose and Hb in the subgroup of men. Among females, a significant relationship between the calculated GFR value was revealed with indicators of systolic and diastolic BP, venous blood glucose and Hb concentration. CONCLUSION Our data indicate the existence of differences in the prevalence of CKD and associated risk factors for the progression of renal failure, depending on gender differences and living conditions of patients. In urban residents, CKD was most often associated with arterial hypertension and renal failure, while overweight, obesity, and proteinuria were significantly more common in rural areas. The incidence of proteinuria and mean levels of systolic BP were significantly higher in females. Further study of the issue under discussion seems promising from the standpoint of a personalized approach and the search for a new preventive strategy to combat both end-stage renal failure and its complications.
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Affiliation(s)
- I T Murkamilov
- Akhunbaev Kyrgyz State Medical Academy
- Yeltsin Kyrgyz-Russian Slavic University
| | - K A Aitbaev
- Research Institute of Molecular Biology and Medicine
| | - V V Fomin
- Sechenov First Moscow State Medical University (Sechenov University)
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Public stroke awareness among Gharbia governorate inhabitants: a cross-sectional study. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2023. [DOI: 10.1186/s41983-023-00629-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
Abstract
Background
Stroke is the most common acquired neurological disease in the adult population worldwide with an incidence of 16 million new cases every year responsible for about 6.1 million deaths and 130.6 million disability-adjusted life-years (DALYs). The objectives of this work were to study the level of stroke awareness and the proper response for suspected stroke patients in urban and rural areas of Tanta City, Egypt. The study was conducted on 1869 Egyptian Citizens; 908 and 961 reside in urban and rural areas, respectively, who were submitted to a face-to-face interview using the stroke awareness questionnaire (Arabic version).
Results
Rural participants showed a significant reduction in acute cerebrovascular stroke (CVS) awareness and knowledge including the most affected organ by CVS, what are the risk factors, what are the early stroke symptoms, is there specific treatment for acute ischemic stroke, and what is the proper reaction when confronted with a case of acute CVS?
Conclusion
Urban populations have better recognition of stroke risk factors, early stroke symptoms, and the proper response when confronted with a case of acute CVS when compared with rural people possibly due to better socioeconomic status and higher educational levels.
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Sommar JN, Segersson D, Flanagan E, Oudin A. Long-term residential exposure to source-specific particulate matter and incidence of diabetes mellitus - A cohort study in northern Sweden. ENVIRONMENTAL RESEARCH 2023; 217:114833. [PMID: 36402182 DOI: 10.1016/j.envres.2022.114833] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
Diabetes mellitus (DM) incidence have been assessed in connection with air pollution exposure in several studies; however, few have investigated associations with source-specific local emissions. This study aims to estimate the risk of DM incidence associated with source-specific air pollution in a Swedish cohort with relatively low exposure. Individuals in the Västerbotten intervention programme cohort were followed until either a DM diagnosis or initiation of treatment with glucose-lowering medication occurred. Dispersion models with high spatial resolution were used to estimate annual mean concentrations of particulate matter (PM) with aerodynamic diameter ≤10 μm (PM10) and ≤2.5 μm (PM2.5) at individual addresses. Hazard ratios were estimated using Cox regression models in relation to moving averages 1-5 years preceding the outcome. During the study period, 1479 incident cases of DM were observed during 261,703 person-years of follow-up. Increased incidence of DM was observed in association with PM10 (4% [95% CI: -54-137%] per 10 μg/m3), PM10-traffic (2% [95% CI: -6-11%] per 1 μg/m3) and PM2.5-exhaust (11% [95% CI: -39-103%] per 1 μg/m3). A negative association was found for both PM2.5 (-18% [95% CI: -99-66%] per 5 μg/m3), but only in the 2nd exposure tertile (-10% [95% CI: -25-9%] compared to the first tertile), and PM2.5-woodburning (-30% [95% CI: -49-4%] per 1 μg/m3). In two-pollutant models including PM2.5-woodburning, there was an 11% [95% CI: -11-38%], 6% [95% CI: -16-34%], 13% [95% CI: -7-36%] and 17% [95% CI: 4-41%] higher risk in the 3rd tertile of PM10, PM2.5, PM10-traffic and PM2.5-exhaust, respectively, compared to the 1st. Although the results lacked in precision they are generally in line with the current evidence detailing particulate matter air pollution from traffic as an environmental risk factor for DM.
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Affiliation(s)
- Johan N Sommar
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
| | - David Segersson
- Swedish Meteorological and Hydrological Institute, Norrköping, Sweden
| | - Erin Flanagan
- Division for Occupational and Environmental Medicine, Department for Laboratory Medicine, Lund University, Lund, Sweden
| | - Anna Oudin
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Division for Occupational and Environmental Medicine, Department for Laboratory Medicine, Lund University, Lund, Sweden
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Asplund S, Lindgren BM, Åström S, Hedlund M, Åhlin J. Organizational and psychosocial environmental work factors associated with self-rated exhaustion disorder among municipal employees in rural northern Sweden. Work 2023; 75:1215-1229. [PMID: 36776096 PMCID: PMC10473146 DOI: 10.3233/wor-220225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 10/06/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Research indicates that good organizational and psychosocial environments are vital to well-functioning workplaces and employee health. Working in the municipal sector and in the rural context may contribute to more health problems, poorer organizational and psychosocial work environments, and higher sick-leave rates. OBJECTIVE The aim of this study was to explore organizational and psychosocial environmental work factors among municipal employees with or without self-rated exhaustion disorder (s-ED) in rural northern Sweden. METHODS The Modern Work Life Questionnaire and the Self-Rated Exhaustion Disorder Scale were used among 1093 municipal employees. RESULTS The results showed that there were significant differences between the s-ED and the non-s-ED group in all but one of the organizational and psychosocial environmental work factors. Various demands, i.e. quantitative, emotional, intellectual, and IT demands were some factors associated with the s-ED group. Social support, resources, and time for work and reflection were some factors associated with the non-s-ED group. Both the s-ED and the non-s-ED groups assessed significantly higher emotional demands and less resources compared to national reference values. CONCLUSION Findings from this study are relevant to a better understanding what organizational and psychosocial work environmental work factor the employer need to pay extra attention to. Addressing risk and protective factors in the work environment could tribute to promote occupational well-being, preventing exhaustion disorder and long-term sick leave among municipal employees in rural northern Sweden.
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Affiliation(s)
- Sofia Asplund
- Department of Nursing, Umeå University, Umeå, Sweden
| | | | - Sture Åström
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Mattias Hedlund
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Johan Åhlin
- Department of Nursing, Umeå University, Umeå, Sweden
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Asplund S, Åhlin J, Åström S, Lindgren BM. Experiences of work-related stress among highly stressed municipal employees in rural northern Sweden. Int J Qual Stud Health Well-being 2022; 17:2056957. [PMID: 35350958 PMCID: PMC8973353 DOI: 10.1080/17482631.2022.2056957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Affiliation(s)
- Sofia Asplund
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Johan Åhlin
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Sture Åström
- Department of Nursing, Umeå University, Umeå, Sweden
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Lifestyle factors as mediators of area-level socio-economic differentials in cardiovascular disease risk factors. The Tromsø Study. SSM Popul Health 2022; 19:101241. [PMID: 36203474 PMCID: PMC9530956 DOI: 10.1016/j.ssmph.2022.101241] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/15/2022] [Accepted: 09/23/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Cardiovascular disease (CVD) is a leading cause of death and disability and living in areas with low socio-economic status (SES) is associated with increased risk of CVD. Lifestyle factors such as smoking, physical inactivity, an unhealthy diet and harmful alcohol use are main risk factors that contribute to other modifiable risk factors, such as hypertension, raised blood cholesterol, obesity, and diabetes. The potential impact of area-level socio-economic status (ASES) on metabolic CVD risk factors via lifestyle behaviors independent of individual SES has not been investigated previously. Aims To estimate associations of ASES with CVD risk factors and the mediating role of lifestyle behaviors independent of individual-level SES. Methods In this cross-sectional study, we included 19,415 participants (52% women) from the seventh survey of the Tromsø Study (2015–2016) (Tromsø7). The exposure variable ASES was created by aggregating individual-level SES variables (education, income, housing ownership) at the geographical subdivision level. Individual-level SES data and geographical subdivision of Tromsø municipality (36 areas) were obtained from Statistics Norway. Variables from questionnaires and clinical examinations obtained from Tromsø7 were used as mediators (smoking, snuff, alcohol, and physical activity), while the outcome variables were body mass index (BMI), total/high-density lipoprotein (HDL) cholesterol ratio, waist circumference, hypertension, diabetes. Mediation and mediated moderation analysis were performed with age as a moderator, stratified by sex. Results ASES was significantly associated with all outcome variables. CVD risk factor level declined with an increase in ASES. These associations were mediated by differences in smoking habits, alcohol use and physical activity. The associations of ASES with total/HDL cholesterol ratio and waist circumference (women) were moderated by age, and the moderating effects were mediated by smoking and physical activity in both sexes. The largest mediated effects were seen in the associations of ASES with total/HDL cholesterol ratio, with the mediators accounting for 43% of the observed effects. Conclusions Living in lower SES areas is associated with increased CVD risk due to unhealthy lifestyle behaviors, such as smoking, alcohol use and physical inactivity. These associations were stronger in women and among older participants.
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Hadley MB, Nalini M, Adhikari S, Szymonifka J, Etemadi A, Kamangar F, Khoshnia M, McChane T, Pourshams A, Poustchi H, Sepanlou SG, Abnet C, Freedman ND, Boffetta P, Malekzadeh R, Vedanthan R. Spatial environmental factors predict cardiovascular and all-cause mortality: Results of the SPACE study. PLoS One 2022; 17:e0269650. [PMID: 35749347 PMCID: PMC9231727 DOI: 10.1371/journal.pone.0269650] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/25/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Environmental exposures account for a growing proportion of global mortality. Large cohort studies are needed to characterize the independent impact of environmental exposures on mortality in low-income settings. METHODS We collected data on individual and environmental risk factors for a multiethnic cohort of 50,045 individuals in a low-income region in Iran. Environmental risk factors included: ambient fine particular matter air pollution; household fuel use and ventilation; proximity to traffic; distance to percutaneous coronary intervention (PCI) center; socioeconomic environment; population density; local land use; and nighttime light exposure. We developed a spatial survival model to estimate the independent associations between these environmental exposures and all-cause and cardiovascular mortality. FINDINGS Several environmental factors demonstrated associations with mortality after adjusting for individual risk factors. Ambient fine particulate matter air pollution predicted all-cause mortality (per μg/m3, HR 1.20, 95% CI 1.07, 1.36) and cardiovascular mortality (HR 1.17, 95% CI 0.98, 1.39). Biomass fuel use without chimney predicted all-cause mortality (reference = gas, HR 1.23, 95% CI 0.99, 1.53) and cardiovascular mortality (HR 1.36, 95% CI 0.99, 1.87). Kerosene fuel use without chimney predicted all-cause mortality (reference = gas, HR 1.09, 95% CI 0.97, 1.23) and cardiovascular mortality (HR 1.19, 95% CI 1.01, 1.41). Distance to PCI center predicted all-cause mortality (per 10km, HR 1.01, 95% CI 1.004, 1.022) and cardiovascular mortality (HR 1.02, 95% CI 1.004, 1.031). Additionally, proximity to traffic predicted all-cause mortality (HR 1.13, 95% CI 1.01, 1.27). In a separate validation cohort, the multivariable model effectively predicted both all-cause mortality (AUC 0.76) and cardiovascular mortality (AUC 0.81). Population attributable fractions demonstrated a high mortality burden attributable to environmental exposures. INTERPRETATION Several environmental factors predicted cardiovascular and all-cause mortality, independent of each other and of individual risk factors. Mortality attributable to environmental factors represents a critical opportunity for targeted policies and programs.
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Affiliation(s)
- Michael B. Hadley
- Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- * E-mail:
| | - Mahdi Nalini
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Samrachana Adhikari
- New York University Grossman School of Medicine, New York, New York, United States of America
| | - Jackie Szymonifka
- New York University Grossman School of Medicine, New York, New York, United States of America
| | - Arash Etemadi
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Farin Kamangar
- Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, Maryland, United States of America
| | - Masoud Khoshnia
- Golestan University of Medical Sciences, Gorgan, Golestan, Iran
| | - Tyler McChane
- Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Akram Pourshams
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Poustchi
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadaf G. Sepanlou
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Christian Abnet
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Neal D. Freedman
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, United States of America
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Reza Malekzadeh
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Rajesh Vedanthan
- New York University Grossman School of Medicine, New York, New York, United States of America
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Sigit FS, Trompet S, Tahapary DL, Harbuwono DS, le Cessie S, Rosendaal FR, de Mutsert R. Adherence to the healthy lifestyle guideline in relation to the metabolic syndrome: Analyses from the 2013 and 2018 Indonesian National Health Surveys. Prev Med Rep 2022; 27:101806. [PMID: 35656214 PMCID: PMC9152785 DOI: 10.1016/j.pmedr.2022.101806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 04/23/2022] [Accepted: 04/24/2022] [Indexed: 11/22/2022] Open
Abstract
In this study, we aimed to investigate differences in lifestyle factors and prevalence of metabolic syndrome (MetS) in the Indonesian population between 2013 and 2018. In addition, we investigated whether adherence to the 2015-released national healthy lifestyle guideline (‘GERMAS’) is associated with MetS in different sex, age, urban/rural, and BMI categories. We performed cross-sectional analyses in individuals aged >15 of the 2013 (n = 34,274) and 2018 (n = 33,786) Indonesian National Health Surveys. A stratified, multi-stage, systematic random sampling design and the probability proportional to size method were used to select households in the 34 provinces across the country. MetS was defined according to the Joint Interim Statement Criteria, and adherence to ‘GERMAS’ guideline was defined as fulfilling the national healthy lifestyle recommendations of ≥150 min/week physical activity (PA), ≥5 portions/day fruit and vegetable (FV), no smoking (NS), and no alcohol consumption (NA). We examined the associations of each lifestyle factor with MetS using logistic regression categorised by sex, age groups, urban/rural, and BMI, and adjusted for sociodemographic factors. We observed that men who adhered to the guideline had lower odds ratio of MetS [OR(95%CI) associated with PA: 0.85(0.75–0.97); NA: 0.75(0.56–1.00)] than non-adherent men. Middle-aged adults who adhered to the guideline had lower OR of MetS [PA: 0.85(0.72–1.01); FV: 0.78(0.62–0.99); NA: 0.66(0.46–0.93)] than non-adherent adults <45 years. The adherent urban population had lower OR of MetS [FV: 0.85(0.67–1.07); NA: 0.74(0.52–1.07)] than the non-adherent urban population. Those with overweight or obesity who adhered to the guideline had relatively lower odds of MetS than those who did not. In conclusion, in this nationally representative study, adherence to the ‘GERMAS’ guideline may confer cardiometabolic health benefits to several groups of the Indonesian population, particularly men, middle-aged, those with overweight and obesity, and potentially urban population.
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Mohd Nor NS, Chua YA, Abdul Razak S, Ismail Z, Nawawi H. Identification of cardiovascular risk factors among urban and rural Malaysian youths. BMC Cardiovasc Disord 2022; 22:70. [PMID: 35196985 PMCID: PMC8867643 DOI: 10.1186/s12872-021-02447-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022] Open
Abstract
Background Coronary artery disease (CAD) is one of the major causes of morbidity and mortality worldwide. Early identification of the cardiovascular risk factors (CRF) among youths assists in determining the high-risk group to develop CAD in later life. In view of the modernised lifestyle, both urban and rural residing youths are thought to be equally exposed to various CRF. This study aimed to describe the common CRF including obesity, dyslipidaemia, hypertension, smoking and family history of hypercholesterolaemia and premature CAD in youths residing in urban and rural areas in Malaysia. Methods We recruited 942 Malaysian subjects aged 15–24 years old [(males = 257, and urban = 555 vs. rural = 387, (mean age ± SD = 20.5 ± 2.1 years)] from the community health screening programmes organised in both rural and urban regions throughout Malaysia. Medical history and standardised anthropometric measurements were recorded. Laboratory investigations were obtained for fasting serum lipid profiles and plasma glucose levels. Results A total of 43.7% from the total study population was either obese or overweight. Youths in the rural were more overweight and obese (49.4% vs. 42.7%, p < 0.044) and have higher family history of hypercholesterolaemia (16.3% vs. 11.3%, p < 0.036) than youths in the urban areas. Low-density lipoprotein (LDL-c) (2.8 vs. 2.7 mmol/L) and total cholesterol (TC) (4.7 vs. 4.5 mmol/L) were significantly higher in urban compared to rural youths (p < 0.019 and p < 0.012). Overall, more youth in this study has CRF rather than not (Has ≥ 1 CRF = 69.9%). Significantly more rural youths have at least one CRF compared to urban youths (rural = 74.2% vs. urban = 66.8%, p = 0.016). Conclusion In conclusion, our study showed that a large number of youths had at least one or more CRF. Rural youths have significantly higher BMI with higher family history of hypercholesterolaemia compared to urban youths. However, urban youths have higher LDL-c and TC levels. Other coronary risk factors are not significantly different between urban and rural youths. Rural youths have more CRF compared to urban youths. A larger longitudinal study focusing on this population is important to better understand the effect of the area of residence on CRF in youth.
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Affiliation(s)
- Noor Shafina Mohd Nor
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Selangor, Malaysia.,Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Selangor, Malaysia
| | - Yung-An Chua
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Selangor, Malaysia
| | - Suraya Abdul Razak
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Selangor, Malaysia.,Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Selangor, Malaysia
| | - Zaliha Ismail
- Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Selangor, Malaysia
| | - Hapizah Nawawi
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Selangor, Malaysia. .,Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Selangor, Malaysia.
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Verheyen VJ, Remy S, Govarts E, Colles A, Koppen G, Martin LR, Nielsen F, Bruckers L, Bijnens EM, Vos S, Morrens B, Coertjens D, Loots I, De Decker A, Franken C, Den Hond E, Nelen V, De Henauw S, Covaci A, Van Larebeke N, Teughels C, Nawrot TS, Schoeters G. Determinants of Chronic Biological Stress, Measured as Hair Cortisol Concentration, in a General Population of Adolescents: From Individual and Household Characteristics to Neighborhood Urbanicity. Front Public Health 2021; 9:669022. [PMID: 34888272 PMCID: PMC8650704 DOI: 10.3389/fpubh.2021.669022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 10/14/2021] [Indexed: 11/13/2022] Open
Abstract
Chronic biological stress may adversely affect adolescents' physical and mental health, but insight in the personal and environmental factors that determine chronic stress is limited. We measured 3-month cumulative hair cortisol concentration (HCC) in 419 adolescents, participating in the Flemish Environment and Health Study. Adolescents' health and lifestyle characteristics, household and neighborhood socio-economic status as well as neighborhood urbanicity were assessed as potential determinants of HCC, using multiple linear regression models. We additionally explored heterogeneity of our results by sex. HCC were significantly higher in boys from densely populated neighborhoods, the association was not significant in girls. Accordingly, boys living outside cities had significantly lower HCC than boys, living in cities. HCC was significantly lower in adolescents with an optimal vitality, a measure of a positive mental health status. In adolescent girls, menarcheal status (pre-/postmenarche) was a significant determinant of HCC. Our findings are the first to suggest that residential urbanicity may have an impact on chronic biological stress in a general population of adolescent boys.
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Affiliation(s)
- Veerle J Verheyen
- VITO Health, Flemish Institute for Technological Research (VITO), Antwerp, Belgium.,Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Sylvie Remy
- VITO Health, Flemish Institute for Technological Research (VITO), Antwerp, Belgium
| | - Eva Govarts
- VITO Health, Flemish Institute for Technological Research (VITO), Antwerp, Belgium
| | - Ann Colles
- VITO Health, Flemish Institute for Technological Research (VITO), Antwerp, Belgium
| | - Gudrun Koppen
- VITO Health, Flemish Institute for Technological Research (VITO), Antwerp, Belgium
| | | | - Flemming Nielsen
- Institute of Public Health, Department of Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Liesbeth Bruckers
- I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium
| | - Esmée M Bijnens
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Stijn Vos
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Bert Morrens
- Department of Sociology, Faculty of Social Sciences, University of Antwerp, Antwerp, Belgium
| | - Dries Coertjens
- Department of Sociology, Faculty of Social Sciences, University of Antwerp, Antwerp, Belgium
| | - Ilse Loots
- Department of Sociology, Faculty of Social Sciences, University of Antwerp, Antwerp, Belgium
| | - Annelies De Decker
- Provincial Institute of Hygiene, Provincial Research Centre for Environment and Health, Antwerp, Belgium
| | - Carmen Franken
- Provincial Institute of Hygiene, Provincial Research Centre for Environment and Health, Antwerp, Belgium
| | - Elly Den Hond
- Provincial Institute of Hygiene, Provincial Research Centre for Environment and Health, Antwerp, Belgium
| | - Vera Nelen
- Provincial Institute of Hygiene, Provincial Research Centre for Environment and Health, Antwerp, Belgium
| | - Stefaan De Henauw
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Adrian Covaci
- Toxicological Centre, University of Antwerp, Antwerp, Belgium
| | - Nicolas Van Larebeke
- Analytical, Environmental and Geo-Chemistry, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Radiotherapy and Experimental Cancerology, Ghent University, Ghent, Belgium
| | - Caroline Teughels
- Flemish Planning Bureau for the Environment and Spatial Development, Brussels, Belgium
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Greet Schoeters
- VITO Health, Flemish Institute for Technological Research (VITO), Antwerp, Belgium.,Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
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Jóhannsdóttir TB, Ingadottir B, Svavarsdóttir MH. Rural patients' experience of education, surveillance, and self-care support after heart disease related hospitalisation: a qualitative study. Int J Circumpolar Health 2021; 80:2007667. [PMID: 34839809 PMCID: PMC8635654 DOI: 10.1080/22423982.2021.2007667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 11/12/2021] [Accepted: 11/12/2021] [Indexed: 11/18/2022] Open
Abstract
People living in rural Iceland have a higher rate of cardiovascular risk factors and healthcare utilisation compared to people in urban areas.The aim of this qualitative study was to explore the experiences of people with coronary heart disease, living in rural Iceland regarding patient education, surveillance, and self-care support. The participants (N = 14, age 52‒79 years, 8 male), were interviewed 6 to 12 months after hospital discharge following a cardiac event (in 2018‒2019). Systematic text-condensation was used for analysis. The findings were categorised into three main themes: Education and support describes inadequate patient education and support from health-care professionals after discharge from hospitaland how the internet was the main information source supplemented with spouse's and family support. Local healthcare services describe thelack of and importance of access to health-care professionals, stable services, and underutilisation of telemedicine and primary healthcare in the local area, and Self-care behaviour describes the lack of professional support with lifestyle changes and how the participants manage self-care as well as their attitudes towards the disease.The results indicate that access to continuous healthcare services and person-centred support focusing on prevention strategies are widely impaired in rural areas in Iceland.
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Affiliation(s)
| | - Brynja Ingadottir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland and Landspitali University Hospital, Reykjavik, Iceland
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Studziński K, Tomasik T, Windak A, Banach M, Wójtowicz E, Mastej M, Tomaszewski M, Mikhailidis DP, Toth PP, Catapano A, Ray KK, Howard G, Lip GY, Charchar FJ, Sattar N, Williams B, MacDonald TM, Penson PE, Jóźwiak JJ. The Differences in the Prevalence of Cardiovascular Disease, Its Risk Factors, and Achievement of Therapeutic Goals among Urban and Rural Primary Care Patients in Poland: Results from the LIPIDOGRAM 2015 Study. J Clin Med 2021; 10:5656. [PMID: 34884357 PMCID: PMC8658414 DOI: 10.3390/jcm10235656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/16/2021] [Accepted: 11/28/2021] [Indexed: 11/30/2022] Open
Abstract
A nationwide cross-sectional study, LIPIDOGRAM2015, was carried out in Poland in the years 2015 and 2016. A total of 438 primary care physicians enrolled 13,724 adult patients that sought medical care in primary health care practices. The prevalence of hypertension, diabetes mellitus, dyslipidaemia, and CVD were similar in urban and rural areas (49.5 vs. 49.4%; 13.7 vs. 13.1%; 84.2 vs. 85.2%; 14.4 vs. 14.2%, respectively). The prevalence of obesity (32.3 vs. 37.5%, p < 0.01) and excessive waist circumference (77.5 vs. 80.7%, p < 0.01), as well as abdominal obesity (43.2 vs. 46.4%, p < 0.01), were higher in rural areas in both genders. Mean levels of LDL-C (128 vs. 130 mg/dL, p = 0.04) and non-HDL-C (147 vs. 148 mg/dL, p = 0.03) were slightly higher in rural populations. Altogether, 14.3% of patients with CVD from urban areas and 11.3% from rural areas reached LDL <70 mg/dL (p = 0.04). There were no important differences in the prevalence of hypertension, diabetes, dyslipidaemia, and CVD, or in mean levels of blood pressure, cholesterol fractions, glucose, and HbA1c between Polish urban and rural primary care patient populations. A high proportion of patients in cities and an even-higher proportion in rural areas did not reach the recommended targets for blood pressure, LDL-C, and HbA1c, indicating the need for novel CVD-prevention programs.
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Affiliation(s)
- Krzysztof Studziński
- Department of Family Medicine, Jagiellonian University Medical College, Bochenska 4, 31-061 Krakow, Poland; (K.S.); (A.W.); (E.W.)
| | - Tomasz Tomasik
- Department of Family Medicine, Jagiellonian University Medical College, Bochenska 4, 31-061 Krakow, Poland; (K.S.); (A.W.); (E.W.)
| | - Adam Windak
- Department of Family Medicine, Jagiellonian University Medical College, Bochenska 4, 31-061 Krakow, Poland; (K.S.); (A.W.); (E.W.)
| | - Maciej Banach
- Polish Mothers Memorial Hospital Research Institute, 93-338 Lodz, Poland;
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, 90-136 Lodz, Poland
- Cardiovascular Research Centre, University of Zielona Gora, 65-417 Zielona Gora, Poland
| | - Ewa Wójtowicz
- Department of Family Medicine, Jagiellonian University Medical College, Bochenska 4, 31-061 Krakow, Poland; (K.S.); (A.W.); (E.W.)
| | | | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PT, UK;
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital, University College London, London NW3 2QG, UK;
| | - Peter P. Toth
- Cicarrone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA;
- CGH Medical Center, Sterling, IL 61081, USA
| | - Alberico Catapano
- Department of Pharmacological Sciences, University of Milano and Multimedica IRCCS, 20099 Milano, Italy;
| | - Kausik K. Ray
- Department of Primary Care and Public Health, Imperial Centre for Cardiovascular Disease Prevention, Imperial College, Kensington, London W6 8RP, UK;
| | - George Howard
- Department of Biostatistics, School of Public Health of Alabama at Birmingham, Birmingham B15 2TT, UK;
| | - Gregory Y.H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool L14 3PE, UK;
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
| | - Fadi J. Charchar
- School of Health and Life Sciences, Federation University Australia, Ballarat, VIC 3350, Australia;
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow G12 8TA, UK;
| | - Bryan Williams
- NIHR University College London Biomedical Research Centre, University College London and University, London NW1 2BU, UK;
- College London Hospitals NHS Foundation Trust, London NW1 2BU, UK
| | - Thomas M. MacDonald
- MEMO Research, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK;
| | - Peter E. Penson
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool L2 2QP, UK;
- Liverpool Centre for Cardiovascular Science, Liverpool L69 7TX, UK
| | - Jacek J. Jóźwiak
- Department of Family Medicine and Public Health, Institute of Medical Sciences, University of Opole, Oleska 48, 45-052 Opole, Poland;
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Richter D, Eyding J, Weber R, Bartig D, Misselwitz B, Grau A, Krogias C. The level of urbanization influences acute ischemic stroke care: A nationwide ecological study from Germany. J Neurol Sci 2021; 430:119983. [PMID: 34534884 DOI: 10.1016/j.jns.2021.119983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/06/2021] [Accepted: 09/10/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Regional differences in acute ischemic stroke (AIS) care are still reported for Germany but not fully understood. We aimed to analyze the impact of the level of urbanization on the application of proved treatment procedures and the incidence of hospitalized AIS cases in Germany. METHODS The level of urbanization of the 401 districts and district-free cities in Germany was defined according to the Federal Institute for Building, Urban Affairs and Spatial Research classification. Using nationwide administrative data, the application of intravenous thrombolysis (IVT), mechanical thrombectomy (MT), and the incidence of hospitalizations for AIS, were analyzed according to the place of residence of the patients. Data included all patients hospitalized for AIS in 2019 (n = 224,274) and sociodemographic information of 83,019,213 residents in Germany. RESULTS Sparsely populated districts had a significantly higher incidence of hospitalizations for AIS than cities (age-standardized: 271.8 versus 242.3 per 100,000 inhabitants, P < 0.001), but a lower use of MT (5.7% versus 8.4%, P < 0.001). In the adjusted negative binomial regression model, rurality remained an independent predictor for MT use and the incidence of AIS hospitalizations. The proportion of IVT did not significantly differ between sparsely populated districts and cities (15.6% versus 17.2%, P = 0.021). CONCLUSIONS Although there is a dense network of stroke units in Germany, the level of urbanization still influences AIS care, as we found a lower proportion of MT and a higher incidence of AIS hospitalizations in Germany's rural areas.
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Affiliation(s)
- Daniel Richter
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Germany
| | - Jens Eyding
- Medical Faculty, Ruhr University Bochum, Germany; Department of Neurology, Gemeinschaftskrankenhaus Herdecke, Germany
| | - Ralph Weber
- Medical Faculty, Ruhr University Bochum, Germany; Department of Neurology, Alfried Krupp Krankenhaus Essen, Germany
| | - Dirk Bartig
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Germany
| | | | - Armin Grau
- Department of Neurology, Klinikum der Stadt Ludwigshafen a.Rh., Germany
| | - Christos Krogias
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Germany; Medical Faculty, Ruhr University Bochum, Germany.
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Morseth B, Geelhoed B, Linneberg A, Johansson L, Kuulasmaa K, Salomaa V, Iacoviello L, Costanzo S, Söderberg S, Niiranen TJ, Vishram-Nielsen JKK, Njølstad I, Wilsgaard T, Mathiesen EB, Løchen ML, Zeller T, Blankenberg S, Ojeda FM, Schnabel RB. Age-specific atrial fibrillation incidence, attributable risk factors and risk of stroke and mortality: results from the MORGAM Consortium. Open Heart 2021; 8:openhrt-2021-001624. [PMID: 34341095 PMCID: PMC8330568 DOI: 10.1136/openhrt-2021-001624] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 07/13/2021] [Indexed: 12/01/2022] Open
Abstract
Background The main aim was to examine age-specific risk factor associations with incident atrial fibrillation (AF) and their attributable fraction in a large European cohort. Additionally, we aimed to examine risk of stroke and mortality in relation to new-onset AF across age. Methods We used individual-level data (n=66 951, 49.1% men, age range 40–98 years at baseline) from five European cohorts of the MOnica Risk, Genetics, Archiving and Monograph Consortium. The participants were followed for incident AF for up to 10 years and the association with modifiable risk factors from the baseline examinations (body mass index (BMI), hypertension, diabetes, daily smoking, alcohol consumption and history of stroke and myocardial infarction (MI)) was examined. Additionally, the participants were followed up for incident stroke and all-cause mortality after new-onset AF. Results AF incidence increased from 0.9 per 1000 person-years at baseline age 40–49 years, to 17.7 at baseline age ≥70 years. Multivariable-adjusted Cox models showed that higher BMI, hypertension, high alcohol consumption and a history of stroke or MI were associated with increased risk of AF across age groups (p<0.05). Between 30% and 40% of the AF risk could be attributed to BMI, hypertension and a history of stroke or MI. New-onset AF was associated with a twofold increase in risk of stroke and death at ages≥70 years (p≤0.001). Conclusion In this large European cohort aged 40 years and above, risk of AF was largely attributed to BMI, high alcohol consumption and a history MI or stroke from middle age. Thus, preventive measures for AF should target risk factors such as obesity and hypertension from early age and continue throughout life.
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Affiliation(s)
- Bente Morseth
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Bastiaan Geelhoed
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Allan Linneberg
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Kari Kuulasmaa
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Veikko Salomaa
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Licia Iacoviello
- Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese, Italy.,Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli (IS), Italy
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli (IS), Italy
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Teemu J Niiranen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Julie K K Vishram-Nielsen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Inger Njølstad
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ellisiv B Mathiesen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tanja Zeller
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Francisco M Ojeda
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Renate B Schnabel
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
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21
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Rudolf H, Kreutzer J, Klaassen-Mielke R, Timmesfeld N, Trampisch HJ, Krause DMJ. Socioeconomic factors and the onset of peripheral artery disease in older adults. VASA 2021; 50:341-347. [PMID: 34254830 DOI: 10.1024/0301-1526/a000961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: As evidence concerning the impact of socioeconomic factors on the risk of peripheral artery disease (PAD) is sparse, we assessed the association of education and area-level factors (population density, type of municipality and local unemployment rate) on the onset of PAD in older adults. Patients and methods: The analysis used data of the getABI study, a prospective cohort study with seven years of follow-up. Onset of PAD was determined by ankle brachial index (<0.9) or PAD symptoms. Cox regression analysis was employed. Results: Out of 5,444 primary care attendees without PAD at baseline, there were 1,381 participants with PAD onset (cumulative observation time 31,739 years), yielding an event rate of 43.5 (0.95 confidence interval [0.95 CI] 41.2-45.8) per 1,000 person-years. Multivariable Cox regression analysis showed an association of PAD onset with low education (hazard ratio 1.29; 0.95 CI 1.14-1.46; P<0.001), high population density (0.93; 0.89-0.98; P=0.002), small cities (compared to large cities) (0.71; 0.53-0.96; P=0.027) and high local unemployment rate (1.04; 1.00-1.07; P=0.032). The impact of low education on PAD onset was higher for men (2.11; 1.64-2.72) than for women (1.22; 1.07-1.40) (interaction term P=0.013). Conclusions: Socioeconomic factors, education as well as area-level socioeconomic indicators, make independent contributions to PAD onset in older adults.
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Affiliation(s)
- Henrik Rudolf
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, Germany
| | - Julia Kreutzer
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, Germany
| | - Renate Klaassen-Mielke
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, Germany
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, Germany
| | - Hans-Joachim Trampisch
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, Germany
| | - Dietmar M J Krause
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, Germany
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22
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Batra A, Kong S, Cheung WY. Associations of Socioeconomic Status and Rurality With New-Onset Cardiovascular Disease in Cancer Survivors: A Population-Based Analysis. JCO Oncol Pract 2021; 17:e1189-e1201. [PMID: 34242068 DOI: 10.1200/op.20.01053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Patients with cancer are predisposed to develop new-onset cardiovascular disease (CVD). We aimed to assess if rural residence and low socioeconomic status modify such a risk. METHODS Patients diagnosed with solid organ cancers without any baseline CVD and on a follow-up of at least 1 year in a large Canadian province from 2004 to 2017 were identified using the population-based registry. We performed logistic regression analyses to examine the associations of rural residence and low socioeconomic status with the development of CVD. RESULTS We identified 81,418 patients eligible for the analysis. The median age was 62 years, and 54.3% were women. At a median follow-up of 68 months, 29.4% were diagnosed with new CVD. The median time from cancer diagnosis to CVD diagnosis was 29 months. Rural patients (32.3% v 28.5%; P < .001) and those with low income (30.4% v 25.9%; P < .001) or low educational attainment (30.7% v 27.6%; P < .001) experienced higher rates of CVD. After adjusting for baseline factors and treatment, rural residence (odds ratio [OR], 1.07; 95% CI, 1.04 to 1.11; P < .001), low income (OR, 1.17; 95% CI, 1.12 to 1.21; P < .001), and low education (OR, 1.08; 95% CI, 1.04 to 1.11; P < .001) continued to be associated with higher odds of CVD. A multivariate Cox regression model showed that patients with low socioeconomic status were more likely to die, but patients residing rurally were not. CONCLUSION Despite universal health care, marginalized populations experience different CVD risk profiles that should be considered when operationalizing lifestyle modification strategies and cardiac surveillance programs for the growing number of cancer survivors.
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Affiliation(s)
- Atul Batra
- Department of Medical Oncology, Tom Baker Cancer Center, Calgary, AB, Canada.,University of Calgary, Calgary, AB, Canada
| | | | - Winson Y Cheung
- Department of Medical Oncology, Tom Baker Cancer Center, Calgary, AB, Canada.,University of Calgary, Calgary, AB, Canada
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23
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Lepori L, Radovanovic D, Schoenenberger AW, Suter PM, Erne P, Parati G, Gallino A, Bianchetti MG, Muggli F. Age-Dependency of Cardiometabolic Risk and Protective Factors in Females Living in a Countryside Area of Switzerland. PRAXIS 2021; 110:252-256. [PMID: 33849291 DOI: 10.1024/1661-8157/a003622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We investigated the effect of age on cardiometabolic risk and protective factors in females living in a countryside area of Switzerland. For this cross-sectional analysis, data from 268 female adults, who live in two neighboring countryside villages in Italian-speaking Switzerland were retained. 89 study participants were premenopausal, 82 climacteric and 97 postmenopausal. Television viewing time, short duration of sleep, overweight, blood pressure, levels of atherogenic lipids and glycated hemoglobin significantly increased with age. Walking time also significantly increased with age. Tobacco smoking was more common among premenopausal women. It is concluded that in these countryside villages climacteric and postmenopausal women generally have an unfavorable cardiometabolic risk profile. On the other side, low physical activity and smoking are, compared to premenopausal and climacteric women, less prevalent in postmenopausal women.
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Affiliation(s)
- Letizia Lepori
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Dragana Radovanovic
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Andreas W Schoenenberger
- Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Paolo M Suter
- Department of Internal Medicine, University Hospital Zurich and University of Zurich, Switzerland
| | - Paul Erne
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Cardiology Unit and Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milano, & Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Augusto Gallino
- Cardiovascular Research, San Giovanni Hospital, Bellinzona, Switzerland
| | - Mario G Bianchetti
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Franco Muggli
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
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24
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Öjefors Stark K, Olofsson N. Daily moderate-intensity physical activities and optimism promote healthy ageing in rural northern Sweden: a cross-sectional study. Int J Circumpolar Health 2021; 80:1867439. [PMID: 33463403 PMCID: PMC7833011 DOI: 10.1080/22423982.2020.1867439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The aim of our study was to explore the association between self-reported health factors and self-rated health (SRH) among an older rural population in northern Sweden and whether confounders optimistic outlook or daily moderate-intensity physical activity could moderate the association between self-reported health factors and SRH, controlling for age. The study is based on a sample (N = 1946) from the “Health on Equal Terms” Västernorrland survey 2018 aged 65–84. Prevalence and multivariate logistic regression analyses were performed. The results indicated most rural older people perceived very good or good SRH, though physical and mental health issues and impaired mobility increased with advanced age. Mental well-being exhibited a stronger association with poor SRH than physical health or impaired mobility. In addition, confounders optimistic outlook and daily moderate-intensity physical activity, separately and together could moderate the association between health factors and poor SRH. In conclusion, older people in a rural setting perceived good health, despite common physical and mental health issues. Promoting daily moderate-intensity physical activity and activities contributing to an optimistic outlook can protect against poor SRH in old age.
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Affiliation(s)
| | - Niclas Olofsson
- Department of Health Sciences, Mid Sweden University , Sundsvall, Sweden.,Department of Research and Development, Region Västernorrland , Sundsvall, Sweden
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25
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Tonne C, Adair L, Adlakha D, Anguelovski I, Belesova K, Berger M, Brelsford C, Dadvand P, Dimitrova A, Giles-Corti B, Heinz A, Mehran N, Nieuwenhuijsen M, Pelletier F, Ranzani O, Rodenstein M, Rybski D, Samavati S, Satterthwaite D, Schöndorf J, Schreckenberg D, Stollmann J, Taubenböck H, Tiwari G, van Wee B, Adli M. Defining pathways to healthy sustainable urban development. ENVIRONMENT INTERNATIONAL 2021; 146:106236. [PMID: 33161201 DOI: 10.1016/j.envint.2020.106236] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/15/2020] [Accepted: 10/22/2020] [Indexed: 05/05/2023]
Abstract
Goals and pathways to achieve sustainable urban development have multiple interlinkages with human health and wellbeing. However, these interlinkages have not been examined in depth in recent discussions on urban sustainability and global urban science. This paper fills that gap by elaborating in detail the multiple links between urban sustainability and human health and by mapping research gaps at the interface of health and urban sustainability sciences. As researchers from a broad range of disciplines, we aimed to: 1) define the process of urbanization, highlighting distinctions from related concepts to support improved conceptual rigour in health research; 2) review the evidence linking health with urbanization, urbanicity, and cities and identify cross-cutting issues; and 3) highlight new research approaches needed to study complex urban systems and their links with health. This novel, comprehensive knowledge synthesis addresses issue of interest across multiple disciplines. Our review of concepts of urban development should be of particular value to researchers and practitioners in the health sciences, while our review of the links between urban environments and health should be of particular interest to those outside of public health. We identify specific actions to promote health through sustainable urban development that leaves no one behind, including: integrated planning; evidence-informed policy-making; and monitoring the implementation of policies. We also highlight the critical role of effective governance and equity-driven planning in progress towards sustainable, healthy, and just urban development.
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Affiliation(s)
- Cathryn Tonne
- ISGlobal, Universitat Pompeu Fabra, CIBER Epidemiología y Salud Pública, Doctor Aiguader 88, 08003 Barcelona, Spain.
| | - Linda Adair
- Gillings School of Public Health, University of North Carolina, Chapel Hill, NC 27516-2524, USA
| | - Deepti Adlakha
- School of Natural and Built Environment, Queen's University Belfast, David Keir Building, 39-123 Stranmillis Road, Belfast BT9 5AG, United Kingdom
| | - Isabelle Anguelovski
- ICREA Catalan Institution for Research and Advanced Studies, 08010 Barcelona, Spain; Universitat Autonoma de Barcelona, 08193 Barcelona, Spain; IMIM Medical Research Institute, Hospital del Mar, 08003 Barcelona, Spain
| | - Kristine Belesova
- Centre on Climate Change and Planetary Health, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Maximilian Berger
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin, Campus Charité Mitte, 10117 Berlin, Germany
| | - Christa Brelsford
- Oak Ridge National Laboratory, 1 Bethel Valley Road, Oak Ridge, TN 37831, USA
| | - Payam Dadvand
- ISGlobal, Universitat Pompeu Fabra, CIBER Epidemiología y Salud Pública, Doctor Aiguader 88, 08003 Barcelona, Spain
| | - Asya Dimitrova
- ISGlobal, Universitat Pompeu Fabra, CIBER Epidemiología y Salud Pública, Doctor Aiguader 88, 08003 Barcelona, Spain
| | - Billie Giles-Corti
- RMIT University, La Trobe Street, GPO Box 2476, Melbourne, VIC 3000, Australia
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin, Campus Charité Mitte, 10117 Berlin, Germany
| | - Nassim Mehran
- Humboldt University, Unter den Linden 6, 10099 Berlin, Germany
| | - Mark Nieuwenhuijsen
- ISGlobal, Universitat Pompeu Fabra, CIBER Epidemiología y Salud Pública, Doctor Aiguader 88, 08003 Barcelona, Spain
| | - François Pelletier
- United Nations Population Division, 2 United Nations Plaza, Rm. DC2-1950, New York, NY 10017 USA
| | - Otavio Ranzani
- ISGlobal, Universitat Pompeu Fabra, CIBER Epidemiología y Salud Pública, Doctor Aiguader 88, 08003 Barcelona, Spain
| | - Marianne Rodenstein
- Goethe University, Westend Campus - PEG Building, Theodor-W.-Adorno-Platz 6, 60323 Frankfurt am Main, Germany
| | - Diego Rybski
- Potsdam Institute for Climate, P.O. Box 60 12 03, Potsdam 14412, Germany
| | - Sahar Samavati
- Tarbiat Modares University, Jalal Ale Ahmad Highway, 9821 Tehran, Iran
| | - David Satterthwaite
- International Institute for Environment and Development, Unit, 80-86 Gray's Inn Road, London WC1X 8NH, UK
| | - Jonas Schöndorf
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin, Campus Charité Mitte, 10117 Berlin, Germany
| | - Dirk Schreckenberg
- ZEUS GmbH, Centre for Applied Psychology, Environmental and Social Research, Sennbrink 46, D-58093 Hagen, Germany
| | - Jörg Stollmann
- Institute of Architecture, TU Berlin, Strasse des 17.Juni 135, 10623 Berlin, Germany
| | - Hannes Taubenböck
- Deutsches Zentrum für Luft- und Raumfahrt, Oberpfaffenhofen, Münchener Str. 20, 82234 Weßling, Germany
| | - Geetam Tiwari
- Indian Institute of Technology Delhi, Hauz Khas, New Delhi, Delhi 110016, India
| | - Bert van Wee
- Delft University of Technology, PO Box 5015, 2600 GA Delft, the Netherlands
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin, Campus Charité Mitte, 10117 Berlin, Germany
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26
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Asplund S, Åhlin J, Åström S, Hedlund M, Lindgren BM, Ericson-Lidman E. Self-rated exhaustion disorder and associated health-related factors among municipal employees in rural areas of northern Sweden. Int Arch Occup Environ Health 2020; 94:659-668. [PMID: 33296011 PMCID: PMC8068702 DOI: 10.1007/s00420-020-01617-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 11/18/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aims of this study among municipal employees in rural areas of northern Sweden were to assess the prevalence of self-rated exhaustion disorder (s-ED), describe plausible between-group differences in self-reported health-related factors among employees with or without s-ED, and identify health-related factors associated with s-ED. METHODS In a cross-sectional study, data were collected from 1093 municipal employees (76.1% women) in two rural areas using an instrument measuring s-ED and health variables drawn from the Modern Worklife Questionnaire (MWQ), the Perceived Stress Scale (PSS), and the National Board of Health and Welfare's questions about physical activity. Comparisons were made between an s-ED and a non-s-ED group. Health-related factors associated with s-ED were identified through a logistic regression. RESULTS Self-rated exhaustion disorder was reported by 21.5% of the participants. Health-related factors associated with s-ED were cognitive problems, sleep problems, depressive symptoms, high stress, poor self-rated health, and stomach problems. There was no statistically significant difference in the prevalence of participants who met the criteria of physical activity among s-ED and non-s-ED group. CONCLUSION Findings from this study suggest that s-ED is more common among municipal employees in rural areas than in other working populations in Sweden. Several health-related factors were associated with s-ED. Regular use of a self-rated instrument in evaluating the organizational and social work environment can identify people at risk of developing exhaustion disorder and requiring long-term sick leave.
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Affiliation(s)
- Sofia Asplund
- Department of Nursing, Umeå University, 90187, Umeå, Sweden.
| | - Johan Åhlin
- Department of Nursing, Umeå University, 90187, Umeå, Sweden
| | - Sture Åström
- Department of Nursing, Umeå University, 90187, Umeå, Sweden
| | - Mattias Hedlund
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
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27
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Sobolewski P, Brola W, Wilczyński J, Szczuchniak W, Wójcik T, Wach-Klink A, Kos M, Kozera G. Cerebral Thrombolysis in Rural Residents Aged ≥ 80. Clin Interv Aging 2020; 15:1737-1751. [PMID: 33061326 PMCID: PMC7522422 DOI: 10.2147/cia.s256070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 08/05/2020] [Indexed: 11/26/2022] Open
Abstract
Purpose The proportion of older people in Poland is higher in rural areas than in urban areas. Thus, we aimed to evaluate treatment rate and factors associated with outcome and safety of intravenous thrombolysis (IVT) in rural residents aged ≥80 years admitted to primary stroke centers. Patients and Methods This study was a retrospective, observational cohort study of 873 patients treated with recombinant tissue plasminogen activator (rt-PA) in primary stroke centers between February 1, 2009 and December 31, 2017. Among them were 527 rural residents and 231 (26.5%) were ≥80 years of age. The analyses between rural and urban patients aged ≥80 and between rural patients aged <80 and aged ≥80 were performed. Results The proportion of patients aged ≥80 treated with rt-PA was comparable in rural and urban residents (27.9% vs 24.3% p = 0.24). Rural patients aged ≥80 were also characterized by lower incidence of cardiovascular risk factors and better patients’ conditions on admission to hospital. Symptomatic intracerebral hemorrhage rate among ≥80-year-old stroke patients was lower in those living in rural areas than in those living in urban areas (5.4% vs 14.3%, p = 0.02); there were no differences regarding mortality and 3-month functional outcome between both populations. The older group of rural patients was characterized by a higher 3-month mortality (28.5% vs 12.6%, p < 0.001) and lower functional independence rate (34.0% vs 50.5%, p < 0.001) than rural younger patients. Antiplatelet (OR 2.43, 95% CI 1.04–5.66, p = 0.04) and anticoagulant therapy before stroke (OR 3.64, 95% CI 1.21–10.99, p = 0.022), early ischemic changes in baseline computerized tomograprpahy (OR 2.65, 95% CI 1.03–6.82, p = 0.043) were associated with unfavorable outcome; and higher National Institute of Health Stroke Scale score on admission (OR 1.01, 95% CI 1.01–1.20, p = 0.039), higher baseline count of white blood cells (OR 1.33, 95% CI 1.10–0.62, p = 0.003) were associated with mortality in rural patients over 80. Conclusion We suggest that rural patients aged ≥80 may be safely treated with IVT in routine practice. However, lower efficacy and a higher mortality must be considered in former use of Vitamin K antagonist and antiplatelet or high white blood cells count.
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Affiliation(s)
- Piotr Sobolewski
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland.,Department of Neurology and Stroke Unit, Holy Spirit Specialist Hospital in Sandomierz, Sandomierz, Poland
| | - Waldemar Brola
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland.,Department of Neurology and Stroke Unit, Saint Lukas Hospital in Końskie, Końskie, Poland
| | | | - Wiktor Szczuchniak
- Department of Neurology and Stroke Unit, Holy Spirit Specialist Hospital in Sandomierz, Sandomierz, Poland
| | - Tomasz Wójcik
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Aleksandra Wach-Klink
- Department of Neurology and Stroke Unit, Holy Spirit Specialist Hospital in Sandomierz, Sandomierz, Poland
| | - Marek Kos
- Department of Neurology and Stroke Unit, Holy Spirit Specialist Hospital in Sandomierz, Sandomierz, Poland.,Department of Public Health, Medical University of Lublin, Lublin, Poland
| | - Grzegorz Kozera
- Medical Simulation Center, Medical University of Gdańsk, Gdańsk, Poland
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28
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Alhabib KF, Batais MA, Almigbal TH, Alshamiri MQ, Altaradi H, Rangarajan S, Yusuf S. Demographic, behavioral, and cardiovascular disease risk factors in the Saudi population: results from the Prospective Urban Rural Epidemiology study (PURE-Saudi). BMC Public Health 2020; 20:1213. [PMID: 32770968 PMCID: PMC7414714 DOI: 10.1186/s12889-020-09298-w] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 07/26/2020] [Indexed: 12/23/2022] Open
Abstract
Background Cardiovascular disease (CVD) is the major cause of death in Saudi Arabia. We aimed to assess associated demographic, behavioral, and CVD risk factors as part of the Prospective Urban Rural Epidemiology (PURE) study. Methods PURE is a global cohort study of adults ages 35–70 years in 20 countries. PURE-Saudi study participants were recruited from 19 urban and 6 rural communities randomly selected from the Central province (Riyadh and Alkharj) between February 2012 and January 2015. Data were stratified by age, sex, and urban vs rural and summarized as means and standard deviations for continuous variables and as numbers and percentages for categorical variables. Proportions and means were compared between men and women, among age groups, and between urban and rural areas, using Chi-square test and t-tests, respectively. Results The PURE-Saudi study enrolled 2047 participants (mean age, 46.5 ± 9.12 years; 43.1% women; 24.5% rural). Overall, 69.4% had low physical activity, 49.6% obesity, 34.4% unhealthy diet, 32.1% dyslipidemia, 30.3% hypertension, and 25.1% diabetes. In addition, 12.2% were current smokers, 15.4% self-reported feeling sad, 16.9% had a history of periods of stress, 6.8% had permanent stress, 1% had a history of stroke, 0.6% had heart failure, and 2.5% had coronary heart disease (CHD). Compared to women, men were more likely to be current smokers and have diabetes and a history of CHD. Women were more likely to be obese, have central obesity, self-report sadness, experience stress, feel permanent stress, and have low education. Compared to participants in urban areas, those in rural areas had higher rates of diabetes, obesity, and hypertension, and lower rates of unhealthy diet, self-reported sadness, stress (several periods), and permanent stress. Compared to middle-aged and older individuals, younger participants more commonly reported an unhealthy diet, permanent stress, and feeling sad. Conclusion These results of the PURE-Saudi study revealed a high prevalence of unhealthy lifestyle and CVD risk factors in the adult Saudi population, with higher rates in rural vs urban areas. National public awareness programs and multi-faceted healthcare policy changes are urgently needed to reduce the future burden of CVD risk and mortality.
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Affiliation(s)
- Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Mohammed A Batais
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Turky H Almigbal
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mostafa Q Alshamiri
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hani Altaradi
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sumathy Rangarajan
- Population Health Research Institute, DBCVS Research Institute, McMaster University, Hamilton, Canada
| | - Salim Yusuf
- Population Health Research Institute, DBCVS Research Institute, McMaster University, Hamilton, Canada
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Xia S, Du X, Guo L, Du J, Arnott C, Lam CSP, Huffman MD, Arima H, Yuan Y, Zheng Y, Wu S, Guang X, Zhou X, Lin H, Cheng X, Anderson CS, Dong J, Ma C. Sex Differences in Primary and Secondary Prevention of Cardiovascular Disease in China. Circulation 2020; 141:530-539. [PMID: 32065775 DOI: 10.1161/circulationaha.119.043731] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Despite improvements in diagnostic and therapeutic interventions to combat cardiovascular disease (CVD) in recent decades, there are significant ongoing access gaps and sex disparities in prevention that have not been adequately quantified in China. METHODS A representative, cross-sectional, community-based survey of adults (aged ≥45 years) was conducted in 7 geographic regions of China between 2014 and 2016. Logistic regression models were used to determine sex differences in primary and secondary CVD prevention, and any interaction by age, education level, and area of residence. Data are presented as adjusted odds ratios (ORs) and 95% CIs. RESULTS Of 47 841 participants (61.3% women), 5454 (57.2% women) had established CVD and 9532 (70.5% women) had a high estimated 10-year CVD risk (≥10%). Only 48.5% and 48.6% of women and 39.3% and 59.8% of men were on any kind of blood pressure (BP)-lowering medication, lipid-lowering medication, or antiplatelet therapy for primary and secondary prevention, respectively. Women with established CVD were significantly less likely than men to receive BP-lowering medications (OR, 0.79 [95% CI, 0.65-0.95]), lipid-lowering medications (OR, 0.69 [95% CI, 0.56-0.84]), antiplatelets (OR, 0.53 [95% CI, 0.45-0.62]), or any CVD prevention medication (OR, 0.62 [95% CI, 0.52-0.73]). Women with established CVD, however, had better BP control (OR, 1.31 [95% CI, 1.14-1.50]) but less well-controlled low-density lipoprotein cholesterol (OR, 0.66 [95% CI, 0.57-0.76]), and were less likely to smoke (OR, 13.89 [95% CI, 11.24-17.15]) and achieve physical activity targets (OR, 1.92 [95% CI, 1.61-2.29]). Conversely, women with high CVD risk were less likely than men to have their BP, low-density lipoprotein cholesterol, and bodyweight controlled (OR, 0.46 [95% CI, 0.38-0.55]; OR, 0.60 [95% CI, 0.52-0.69]; OR, 0.55 [95% CI, 0.48-0.63], respectively), despite a higher use of BP-lowering medications (OR, 1.21 [95% CI, 1.01-1.45]). Younger patients (<65 years) with established CVD were less likely to be taking CVD preventive medications, but there were no sex differences by area of residence or education level. CONCLUSIONS Large and variable gaps in primary and secondary CVD prevention exist in China, particularly for women. Effective CVD prevention requires an improved overall nationwide strategy and a special emphasis on women with established CVD, who have the greatest disparity and the most to benefit.
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Affiliation(s)
- Shijun Xia
- Beijing Anzhen Hospital, Capital Medical University, China (S.X., X.D., L.G., J. Dong, C.M.)
| | - Xin Du
- Beijing Anzhen Hospital, Capital Medical University, China (S.X., X.D., L.G., J. Dong, C.M.).,Heart Health Research Centre, Beijing, China (X.D., C.S.A.).,The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (X.D., C.A., C.S.P.L., M.D.H., C.S.A.)
| | - Lizhu Guo
- Beijing Anzhen Hospital, Capital Medical University, China (S.X., X.D., L.G., J. Dong, C.M.)
| | - Jing Du
- Beijing Centre for Disease Prevention and Control, China (J. Du)
| | - Clare Arnott
- Heart Health Research Centre, Beijing, China (X.D., C.S.A.).,The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (X.D., C.A., C.S.P.L., M.D.H., C.S.A.).,Cardiology Department (C.A.), Royal Prince Alfred Hospital, Sydney, Australia.,Sydney Medical School, University of Sydney, Australia (C.A.)
| | - Carolyn S P Lam
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (X.D., C.A., C.S.P.L., M.D.H., C.S.A.).,National Heart Centre Singapore and Duke-National University of Singapore (C.S.P.L.).,University Medical Centre Groningen, The Netherlands (C.S.P.L.)
| | - Mark D Huffman
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (X.D., C.A., C.S.P.L., M.D.H., C.S.A.).,Northwestern University Feinberg School of Medicine, Chicago, IL (M.D.H.)
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Japan (H.A.)
| | - Yiqiang Yuan
- The Seventh People's Hospital of Zhengzhou, Henan Province, China (Y.Y.)
| | - Yang Zheng
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China (Y.Z.)
| | - Shulin Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (S.W.)
| | - Xuefeng Guang
- Department of Cardiology, Yanan Hospital of Kunming, Kunming, Yunnan Province, China (X.G.)
| | - Xianhui Zhou
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumchi, Xinjiang Uyghur Autonomous Region, China (X.Z.)
| | - Hongbo Lin
- Yinzhou District Centre for Disease Control and Prevention, Ningbo, Zhejiang Province, China (H.L.)
| | - Xiaoshu Cheng
- Cardiovascular Department, The Second Affiliated Hospital of Nanchang University, Jiangxi Province, China (X.C.)
| | - Craig S Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (X.D., C.A., C.S.P.L., M.D.H., C.S.A.).,Neurology Department (C.S.A.), Royal Prince Alfred Hospital, Sydney, Australia.,The George Institute China at Peking University Health Science Centre, China (C.S.A.)
| | - Jianzeng Dong
- Beijing Anzhen Hospital, Capital Medical University, China (S.X., X.D., L.G., J. Dong, C.M.).,The First Affiliated Hospital of Zhengzhou University, Henan Province, China (J. Dong)
| | - Changsheng Ma
- Beijing Anzhen Hospital, Capital Medical University, China (S.X., X.D., L.G., J. Dong, C.M.)
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Bertomeu-González V, Soriano Maldonado C, Bleda-Cano J, Carrascosa-Gonzalvo S, Navarro-Perez J, López-Pineda A, Carratalá-Munuera C, Gil Guillén VF, Quesada JA, Brotons C, Orozco-Beltrán D. Predictive validity of the risk SCORE model in a Mediterranean population with dyslipidemia. Atherosclerosis 2019; 290:80-86. [DOI: 10.1016/j.atherosclerosis.2019.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/15/2019] [Accepted: 09/19/2019] [Indexed: 12/13/2022]
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Nuotio J, Vähämurto L, Pahkala K, Magnussen CG, Hutri-Kähönen N, Kähönen M, Laitinen T, Taittonen L, Tossavainen P, Lehtimäki T, Jokinen E, Viikari JSA, Raitakari O, Juonala M. CVD risk factors and surrogate markers - Urban-rural differences. Scand J Public Health 2019; 48:752-761. [PMID: 31464561 DOI: 10.1177/1403494819869816] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: Disparity in cardiovascular disease (CVD) mortality and risk factor levels between urban and rural regions has been confirmed worldwide. The aim of this study was to examine how living in different community types (urban-rural) in childhood and adulthood are related to cardiovascular risk factors and surrogate markers of CVD such as carotid intima-media thickness (IMT) and left ventricular mass (LVM). Methods: The study population comprised 2903 participants (54.1% female, mean age 10.5 years in 1980) of the Cardiovascular Risk in Young Finns Study who had been clinically examined in 1980 (age 3-18 years) and had participated in at least one adult follow-up (2001-2011). Results: In adulthood, urban residents had lower systolic blood pressure (-1 mmHg), LDL-cholesterol (-0.05 mmol/l), lower body mass index (-1.0 kg/m2) and glycosylated haemoglobin levels (-0.05 mmol/mol), and lower prevalence of metabolic syndrome (19.9 v. 23.7%) than their rural counterparts. In addition, participants continuously living in urban areas had significantly lower IMT (-0.01 mm), LVM (1.59 g/m2.7) and pulse wave velocity (-0.22 m/s) and higher carotid artery compliance (0.07%/10 mmHg) compared to persistently rural residents. The differences in surrogate markers of CVD were only partially attenuated when adjusted for cardiovascular risk factors. Conclusions: Participants living in urban communities had a more favourable cardiovascular risk factor profile than rural residents. Furthermore, participants continuously living in urban areas had less subclinical markers related to CVD compared with participants living in rural areas. Urban-rural differences in cardiovascular health might provide important opportunities for optimizing prevention by targeting areas of highest need.
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Affiliation(s)
- Joel Nuotio
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland.,Heart Centre, Turku University Hospital and University of Turku, Finland
| | - Lauri Vähämurto
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland
| | - Katja Pahkala
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland.,Paavo Nurmi Centre, Department of Physical Activity and Health, University of Turku, Finland
| | - Costan G Magnussen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland.,Menzies Research Institute Tasmania, University of Tasmania, Australia
| | - Nina Hutri-Kähönen
- Department of Paediatrics, University of Tampere and Tampere University Hospital, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, University of Tampere School of Medicine and Tampere University Hospital, Finland
| | - Tomi Laitinen
- Department of Clinical Physiology and Nuclear Medicine, University of Eastern Finland and Kuopio University Hospital, Finland
| | | | | | - Terho Lehtimäki
- Fimlab Laboratories and Finnish Cardiovascular Research Centre-Tampere, University of Tampere, Finland
| | - Eero Jokinen
- Department of Pediatric Cardiology, Hospital for Children and Adolescents, University of Helsinki, Finland
| | | | - Olli Raitakari
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Finland
| | - Markus Juonala
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland.,Department of Medicine, University of Turku, Finland.,Murdoch Children's Research Institute, Melbourne, Australia
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Moreno-Lostao A, Guerras JM, Lostao L, de la Fuente L, Martínez D, Rodríguez-Artalejo F, Regidor E. Cardiovascular mortality and risk behaviours by degree of urbanization before, during and after the economic crisis in Spain. BMC Public Health 2019; 19:1109. [PMID: 31412835 PMCID: PMC6694539 DOI: 10.1186/s12889-019-7427-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/31/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND To estimate the relationship of the degree of urbanization to cardiovascular mortality and to risk behaviours before, during and after the 2008 economic crisis in Spain. METHODS In three areas of residence - large urban areas, small urban areas and rural areas - we calculated the rate of premature mortality (0-74 years) from cardiovascular diseases before the crisis (2005-2007), during the crisis (2008-2010 and 2011-2013) and after the crisis (2014-2016), and the prevalence of risk behaviours in 2006, 2011 and 2016. In each period we estimated the mortality rate ratio (MRR) and the prevalence ratio, taking large urban areas as the reference. RESULTS In men, no significant differences were observed in mortality between the two urban areas, while the MRR in rural areas went from 0.92 [95% confidence interval, 0.90-0.94) in 2005-2007 to 0.94 (0.92-0.96) in 2014-2016. In women, no significant differences were observed in mortality between the rural and large urban areas, whereas the MRR in small urban areas decreased from 1.11 (1.08-1.14) in 2005-2007 to 1.06 (1.02-1.09) in 2014-2016. The rural areas had the lowest prevalence of smoking, obesity and physical inactivity in men, and of obesity in women. No significant differences were observed in smoking or physical inactivity by area of residence in women. CONCLUSION The pattern of cardiovascular mortality by degree of urbanization was similar before and after the crisis, although in women the excess mortality in small urban areas with respect to large urban areas was smaller after the crisis. The different pattern of risk behaviours in men and women, according to area of residence, could explain these findings.
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Affiliation(s)
- Almudena Moreno-Lostao
- National Epidemiology Center, Instituto de Salud Carlos III, Monforte de Lemos 5, 28029, Madrid, Spain.
| | - Juan M Guerras
- National Epidemiology Center, Instituto de Salud Carlos III, Monforte de Lemos 5, 28029, Madrid, Spain
| | - Lourdes Lostao
- Department of Sociology, Universidad Pública de Navarra, Pamplona, Spain
| | - Luis de la Fuente
- National Epidemiology Center, Instituto de Salud Carlos III, Monforte de Lemos 5, 28029, Madrid, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - David Martínez
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz, Madrid, Spain.,IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Enrique Regidor
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Li Y, Zhang X, Sang H, Niu X, Liu T, Liu W, Li J. Urban-rural differences in risk factors for ischemic stroke in northern China. Medicine (Baltimore) 2019; 98:e15782. [PMID: 31124971 PMCID: PMC6571368 DOI: 10.1097/md.0000000000015782] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/08/2019] [Accepted: 05/01/2019] [Indexed: 12/13/2022] Open
Abstract
This study aims to investigate urban-rural differences in characteristics and risk factors of ischemic stroke in northern China.The present cross-sectional study was based on the High-risk Population Screening and Intervention Project for Stroke. The cluster sampling method was used to select urban and rural screening sites in northern China. By collecting information and screening the data, patients with ischemic stroke were obtained and a control group with similar gender, age, and regional distribution was selected among the nonischemic stroke patients. Then, the demographic and risk factors of patients with ischemic stroke were described and analyzed.The prevalence of ischemic stroke in northern China was 2.88%, with a greater prevalence in rural areas than in urban areas (3.32% vs 2.43%), and a greater prevalence in males than in females (3.06% vs 2.73%). Furthermore, rural stroke patients were younger than urban stroke patients. Hypertension, family history of stroke, and smoking were the top 3 independent risk factors for ischemic stroke. Overweight/obesity and low education were associated with increased ischemic stroke in urban areas, while low education was associated with less ischemic stroke in rural areas. In addition, the prevalence of alcoholism, dyslipidemia, diabetes, and obvious overweight/obesity was greater in urban areas, while high-salt diet and low education and income were more prevalent in rural regions. Moreover, the smoking index was higher in rural areas than in urban areas.The characteristics and risk factors of ischemic stroke differ between rural and urban areas, which could be used to design specific preventative measures.
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Affiliation(s)
- Yang Li
- Department of Neurology, the First Hospital of Shanxi Medical University, Taiyuan
| | - Xin Zhang
- Department of Neurology, with the Coal Group General Hospital, Datong
| | - Hui Sang
- Department of Neurology, Taiyuan Central Hospital, Taiyuan
| | - Xiaoyuan Niu
- Department of Neurology, the First Hospital of Shanxi Medical University, Taiyuan
| | - Tingting Liu
- Department of Neurology, the First Hospital of Shanxi Medical University, Taiyuan
| | - Weidong Liu
- Neurosurgical Department, Liaocheng People's Hospital, Liaocheng
| | - Jian Li
- Department of Neurology, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
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Javor A, Ferrari J, Posekany A, Asenbaum-Nan S. Stroke risk factors and treatment variables in rural and urban Austria: An analysis of the Austrian Stroke Unit Registry. PLoS One 2019; 14:e0214980. [PMID: 30970026 PMCID: PMC6457636 DOI: 10.1371/journal.pone.0214980] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 03/24/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Differences in stroke risk factors and treatment variables between rural and urban regions in Austria were analyzed retrospectively as European data on this topic are scarce. RESEARCH DESIGN AND METHODS We performed statistical analysis using group comparisons and time series analysis of data of the Austrian Stroke Unit Registry between 2005 and 2016. 87411 patients were divided into three groups (rural, intermediate, urban) according to the degree of urbanisation classification of the European Commission/Eurostat. RESULTS Patients in the rural group were significantly younger, more often female, had a lower pre-stroke disability, and were more frequently transported by an emergency physician. Vascular risk factors were significantly higher in urban patients, leading to a higher rate of microangiopathic etiology. Onset-to-door (ODT) and Onset-to-treatment times were significantly higher in the rural group, but ODTs decreased over time. Door-to-needle times and time to first vascular imaging were significantly lower in the rural group. Intravenous thrombolysis and rehabilitation rates were lower in urban patients. DISCUSSION AND IMPLICATIONS Contrary to previous literature predominantly from outside of Europe, vascular risk factors were higher in Austrian urban patients. Further, rural patients had higher intravenous thrombolysis and rehabilitation rates maybe because of lower pre-stroke disability. ODTs in rural patients were generally higher, but they decreased over time, which might be a consequence of better education of the public in noticing early stroke signs, better transportation and education of emergency medical personnel, better advance notification to the receiving hospital and implementation of Stroke Units in rural areas.
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Affiliation(s)
- Andrija Javor
- Department of Neurology, General Hospital Amstetten, Amstetten, Austria
| | - Julia Ferrari
- Department of Neurology, Hospital St. John´s of God, Vienna, Austria
| | - Alexandra Posekany
- Department of Clinical Neuroscience, Danube University Krems, Krems an der Donau, Austria
- Gesundheit Österreich GmbH/BIQG, Vienna, Austria
| | - Susanne Asenbaum-Nan
- Department of Neurology, General Hospital Amstetten, Amstetten, Austria
- * E-mail:
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Amiri P, Vahedi-Notash G, Naseri P, Khalili D, Hashemi Nazari SS, Mehrabi Y, Mahdavi Hazaveh AR, Azizi F, Hadaegh F. National trends of pre-hypertension and hypertension among Iranian adolescents across urban and rural areas (2007-2011). Biol Sex Differ 2019; 10:15. [PMID: 30922399 PMCID: PMC6439987 DOI: 10.1186/s13293-019-0230-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/18/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The current nationwide study, for the first time, aimed to assess and compare the trend of pre-hypertension and hypertension among urban and rural adolescents in Iran. METHODS This study has been conducted in the framework of the National Surveys of Risk Factors for Non-Communicable Diseases. To estimate pre-hypertension and hypertension prevalence among 9715 adolescents, aged 15-19 years, data collected in four repeated cross-sectional surveys (2007-2011) has been used. The prevalence trends of pre-hypertension and hypertension were examined across urban and rural areas of Iran. To calculate the adjusted prevalence ratios (PRs) of pre-hypertension and hypertension over cycles across area of residence and genders, a complex sample survey and multinomial logistic analysis were performed. RESULTS Using the definition of pre-hypertension and hypertension presented by the seventh Joint National Committee (JNC-VII) for adolescents, after adjusting for confounders, the prevalence of pre-hypertension changed in both urban (boys:28.96% to 29.24% and girls:18.33% to 20.06%) and rural (boys 31.58% to 32.05% and girls 22.25% to 24.13%) areas over the study duration. Non-significant rising prevalence of hypertension was also observed in boys and girls of both regions (urban 12.76% to 15.04% and 8.02% to 9.06%; rural 9.95% to 11.79% and 10.35% to 11.60%, for boys and girls respectively). The adjusted prevalence ratios (PRs) of pre-hypertension (2.16; 95% CI 1.68-2.79 and 1.92, 95% CI 1.57-2.34, in urban and rural, respectively) and hypertension (2.40; 95% CI 1.65-3.51 and 1.82, 95% CI 1.36-2.45, in urban and rural, respectively) were higher in boys than girls. Comparing the adjusted PRs of pre-hypertension and hypertension in urban versus rural areas, in both genders, showed higher PRs of pre-hypertension in rural girls (1.33, 95% CI 1.01-1.75). CONCLUSION The current results showed high constant trends of pre-hypertension and hypertension in Iranian boys and girls, residing in both urban and rural areas.
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Affiliation(s)
- Parisa Amiri
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Golnaz Vahedi-Notash
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parisa Naseri
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Saeed Hashemi Nazari
- Safety Promotion and Injury Prevention Research Center, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yadollah Mehrabi
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Reza Mahdavi Hazaveh
- Center for Non-communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Rostohar Bijelić B, Petek M, Kadojić M, Bijelić N, Kadojić D. Distribution of Stroke Risk Factors in Eastern Croatia. Acta Clin Croat 2018; 57:103-109. [PMID: 30256017 PMCID: PMC6400360 DOI: 10.20471/acc.2018.57.01.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 12/11/2017] [Indexed: 12/22/2022] Open
Abstract
The aim of this study was to determine the distribution of risk factors according to age, gender, subtypes and recurrence of stroke in eastern Croatia. The study included 250 acute stroke patients admitted to University Department of Neurology, Osijek University Hospital Centre in 2011. Patients were grouped according to age, gender, subtypes and recurrence of stroke. The study showed significant differences in the distribution of cigarette smoking, diabetes, cardiomyopathy and hyperuricemia according to patient age. According to gender, male patients had a significantly higher prevalence of smoking and alcohol abuse, whereas in female patients the prevalence of arterial hypertension, atrial fibrillation and hyperuricemia was significantly higher. Regarding stroke subtypes, significant differences were noticed in the prevalence of arterial hypertension, atrial fibrillation, cardiomyopathy and cerebral blood vessel stenosis. Atrial fibrillation was significantly more common in first-ever than in recurrent stroke. Study results identified the groups of patients requiring special attention regarding particular risk factors in eastern Croatia and emphasized the need of developing regional strategies of screening, prevention and holistic care for stroke patients.
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Affiliation(s)
| | - Marta Petek
- University Department of Neurology, Osijek University Hospital Centre, Osijek, Croatia
| | - Mira Kadojić
- Department of Physical Medicine and Rehabilitation, Osijek University Hospital Centre, Bizovac, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Nikola Bijelić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Dragutin Kadojić
- University Department of Neurology, Osijek University Hospital Centre, Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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Carrillo-Larco RM, Miranda JJ, Gilman RH, Checkley W, Smeeth L, Bernabé-Ortiz A. Trajectories of body mass index and waist circumference in four Peruvian settings at different level of urbanisation: the CRONICAS Cohort Study. J Epidemiol Community Health 2018; 72:397-403. [PMID: 29472520 PMCID: PMC5909748 DOI: 10.1136/jech-2017-209795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 12/31/2017] [Accepted: 01/26/2018] [Indexed: 11/29/2022]
Abstract
Background Studies have reported the incidence/risk of becoming obese, but few have described the trajectories of body mass index (BMI) and waist circumference (WC) over time, especially in low/middle-income countries. We assessed the trajectories of BMI and WC according to sex in four sites in Peru. Methods Data from the population-based CRONICAS Cohort Study were analysed. We fitted a population-averaged model by using generalised estimating equations. The outcomes of interest, with three data points over time, were BMI and WC. The exposure variable was the factorial interaction between time and study site. Results At baseline mean age was 55.7 years (SD: 12.7) and 51.6% were women. Mean follow-up time was 2.5 years (SD: 0.4). Over time and across sites, BMI and WC increased linearly. The less urbanised sites showed a faster increase than more urbanised sites, and this was also observed after sex stratification. Overall, the fastest increase was found for WC compared with BMI. Compared with Lima, the fastest increase in WC was in rural Puno (coefficient=0.73, P<0.001), followed by urban Puno (coefficient=0.59, P=0.001) and Tumbes (coefficient=0.22, P=0.088). Conclusions There was a linear increase in BMI and WC across study sites, with the greatest increase in less urbanised areas. The ongoing urbanisation process, common to Peru and other low/middle-income countries, is accompanied by different trajectories of increasing obesity-related markers.
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Affiliation(s)
- Rodrigo M Carrillo-Larco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert H Gilman
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Área de Investigación y Desarrollo, AB PRISMA, Lima, Peru
| | - William Checkley
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Liam Smeeth
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Antonio Bernabé-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Goicolea I, Carson D, San Sebastian M, Christianson M, Wiklund M, Hurtig AK. Health care access for rural youth on equal terms? A mixed methods study protocol in northern Sweden. Int J Equity Health 2018; 17:6. [PMID: 29325552 PMCID: PMC5765630 DOI: 10.1186/s12939-018-0718-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/04/2018] [Indexed: 12/02/2022] Open
Abstract
Background The purpose of this paper is to propose a protocol for researching the impact of rural youth health service strategies on health care access. There has been no published comprehensive assessment of the effectiveness of youth health strategies in rural areas, and there is no clearly articulated model of how such assessments might be conducted. The protocol described here aims to gather information to; i) Assess rural youth access to health care according to their needs, ii) Identify and understand the strategies developed in rural areas to promote youth access to health care, and iii) Propose actions for further improvement. The protocol is described with particular reference to research being undertaken in the four northernmost counties of Sweden, which contain a widely dispersed and diverse youth population. Methods The protocol proposes qualitative and quantitative methodologies sequentially in four phases. First, to map youth access to health care according to their health care needs, including assessing horizontal equity (equal use of health care for equivalent health needs,) and vertical equity (people with greater health needs should receive more health care than those with lesser needs). Second, a multiple case study design investigates strategies developed across the region (youth clinics, internet applications, public health programs) to improve youth access to health care. Third, qualitative comparative analysis of the 24 rural municipalities in the region identifies the best combination of conditions leading to high youth access to health care. Fourth, a concept mapping study involving rural stakeholders, care providers and youth provides recommended actions to improve rural youth access to health care. Discussion The implementation of this research protocol will contribute to 1) generating knowledge that could contribute to strengthening rural youth access to health care, as well as to 2) advancing the application of mixed methods to explore access to health care.
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Affiliation(s)
- Isabel Goicolea
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
| | - Dean Carson
- Demography and Growth Planning, Northern Institute, Charles Darwin University, Darwin, Australia.,Centre for Rural Medicine, Storuman, Sweden.,Arctic Centre at Umeå University, Umeå, Sweden
| | - Miguel San Sebastian
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Maria Wiklund
- Unit of Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Anna-Karin Hurtig
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Diederichs C, Neuhauser H, Rücker V, Busch MA, Keil U, Fitzgerald AP, Heuschmann PU. Predicted 10-year risk of cardiovascular mortality in the 40 to 69 year old general population without cardiovascular diseases in Germany. PLoS One 2018; 13:e0190441. [PMID: 29293619 PMCID: PMC5749805 DOI: 10.1371/journal.pone.0190441] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/14/2017] [Indexed: 11/18/2022] Open
Abstract
AIMS To estimate the 10-year risk of fatal cardiovascular disease (CVD) in the 40 to 69 year old general population in Germany stratified by sex and to analyze differences between socio-economic status (SES), region and community size in individuals without CVD. The analysis is based on the newly recalibrated SCORE Deutschland risk charts and considered other comorbidities for the classification of the high CVD risk group according to the guidelines of the European Society of Cardiology. METHODS AND RESULTS In 3,498 participants (40-69 years) from the German Health Examination Survey for Adults 2008-2011 (DEGS1) without a history of CVD (myocardial infarction, coronary heart disease, heart failure, stroke) we estimated the proportion with a low (SCORE <1%), moderate (SCORE 1-<5%) and high 10-year CVD mortality risk (SCORE ≥5% or diabetes, renal insufficiency, SBP/DPB ≥180/110 mmHg or cholesterol >8 mmol/l). The prevalence of low, moderate and high risk was 42.8%, 38.5% and 18.8% in men and 73.7%, 18.1% and 8.2% in women. The prevalence of high risk was significantly lower in women with a high compared to a low SES (3.3% vs. 11.2%) and in communities with ≥100.000 inhabitants compared to <20.000 inhabitants (5.4% vs.10.9%). There were no significant associations between predicted CVD mortality risk and SES or community size in men and regions in men and women. Among the high risk group, 58.2% of men and 9.8% of women had SCORE ≥5%, leaving the majority of women (60.1%) classified as high risks due to diabetes and SCORE <5%. CONCLUSION Our results suggest the persistence of socioeconomic disparities in predicted cardiovascular mortality in women and support the need of large-scale prevention efforts beyond individual lifestyle modification or treatment. Furthermore, the importance of additional comorbidities for the high risk group classification is highlighted.
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Affiliation(s)
- Claudia Diederichs
- Department of Epidemiology and Health Monitoring, Robert Koch Institute Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- * E-mail:
| | - Hannelore Neuhauser
- Department of Epidemiology and Health Monitoring, Robert Koch Institute Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Viktoria Rücker
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Markus A. Busch
- Department of Epidemiology and Health Monitoring, Robert Koch Institute Berlin, Berlin, Germany
| | - Ulrich Keil
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Anthony P. Fitzgerald
- Department of Epidemiology and Public Health, Department of Statistics, University College Cork, Cork, Ireland
| | - Peter U. Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Center Würzburg, University of Würzburg, Würzburg, Germany
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Riegel B, Moser DK, Buck HG, Dickson VV, Dunbar SB, Lee CS, Lennie TA, Lindenfeld J, Mitchell JE, Treat-Jacobson DJ, Webber DE. Self-Care for the Prevention and Management of Cardiovascular Disease and Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association. J Am Heart Assoc 2017; 6:e006997. [PMID: 28860232 PMCID: PMC5634314 DOI: 10.1161/jaha.117.006997] [Citation(s) in RCA: 273] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Self-care is defined as a naturalistic decision-making process addressing both the prevention and management of chronic illness, with core elements of self-care maintenance, self-care monitoring, and self-care management. In this scientific statement, we describe the importance of self-care in the American Heart Association mission and vision of building healthier lives, free of cardiovascular diseases and stroke. The evidence supporting specific self-care behaviors such as diet and exercise, barriers to self-care, and the effectiveness of self-care in improving outcomes is reviewed, as is the evidence supporting various individual, family-based, and community-based approaches to improving self-care. Although there are many nuances to the relationships between self-care and outcomes, there is strong evidence that self-care is effective in achieving the goals of the treatment plan and cannot be ignored. As such, greater emphasis should be placed on self-care in evidence-based guidelines.
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Alberty R, Studenčan M, Kovář F. Prevalence of Conventional Cardiovascular Risk Factors in Patients with Acute Coronary Syndromes in Slovakia. Cent Eur J Public Health 2017; 25:77-84. [PMID: 28399360 DOI: 10.21101/cejph.a4351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 07/07/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Acute coronary syndrome (ACS) is a major health problem and the leading cause of death and disability in Slovakia. This is the first study to describe the prevalence rate of conventional cardiovascular risk factors in patients hospitalized for ACS. METHODS Hypertension, diabetes mellitus, hyperlipidemia and cigarette smoking were documented in 1,567 cases (mean age, SD: 66.1±12.0 years, 34.8% of females) enrolled in the SLOVAKS registry from August 2011 through September 2011. RESULTS Overall, 83.5% (95% CI, 81.6-85.2%) of the patients with ACS had hypertension, 65.0% (62.5-67.2%) had a hyperlipidemic profile, 32.6% (30.3-34.9%) were diagnosed with diabetes, and 27.6% (25.1-29.8%) were smokers at the time of a heart-related event. Only 5% of patients with ACS lacked any of the 4 conventional risk factors. Higher prevalence rates of all major risk factors, except smoking, were detected in women than in men, in older (≥65 years of age) than younger patients, and in rural (<2,000 inhabitants) than in urban areas. Premature ACS (<45 years of age) was associated with smoking in men, and smoking and hypertension in women. Smoking, in all risk factor combinations, reduced the age at the time of a heart-related event, on average, by 10.0 years in men and by 12.4 years in women. CONCLUSION The results of this study suggest an appreciable burden of major cardiovascular risk factors and also highlight differences that may aid the targeting of public health interventions.
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Affiliation(s)
- Roman Alberty
- Department of Biology and Ecology, Faculty of Natural Sciences, Matej Bel University, Banská Bystrica, Slovakia
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HUBACEK JA, STANEK V, GEBAUEROVA M, ADAMKOVA V, LESAUSKAITE V, ZALIADUONYTE-PEKSIENE D, TAMOSIUNAS A, SUPIYEV A, KOSSUMOV A, ZHUMADILOVA A, PITHA J. Traditional Risk Factors of Acute Coronary Syndrome in Four Different Male Populations – Total Cholesterol Value Does Not Seem To Be Relevant Risk Factor. Physiol Res 2017; 66:S121-S128. [DOI: 10.33549/physiolres.933597] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Cardiovascular diseases are the most common cause of mortality and morbidity in most populations. As the traditional modifiable risk factors (smoking, hypertension, dyslipidemia, diabetes mellitus, and obesity) were defined decades ago, we decided to analyze recent data in patients who survived acute coronary syndrome (ACS). The Czech part of the study included data from 999 males, and compared them with the post-MONICA study (1,259 males, representing general population). The Lithuanian study included 479 male patients and 456 age-matched controls. The Kazakhstan part included 232 patients and 413 controls. In two countries, the most robust ACS risk factor was smoking (OR 3.85 in the Czech study and 5.76 in the Lithuanian study), followed by diabetes (OR 2.26 and 2.07) and hypertension (moderate risk elevation with OR 1.43 and 1.49). These factors did not influence the ACS risk in Kazakhstan. BMI had no significant effect on ACS and plasma cholesterol was surprisingly significantly lower (P<0.001) in patients than in controls in all countries (4.80±1.11 vs. 5.76±1.06 mmol/l in Czechs; 5.32±1.32 vs. 5.71±1.08 mmol/l in Lithuanians; 4.88±1.05 vs. 5.38±1.13 mmol/l in Kazakhs/Russians). Results from our study indicate substantial heterogeneity regarding major CVD risk factors in different populations with the exception of plasma total cholesterol which was inversely associated with ACS risk in all involved groups. These data reflect ethnical and geographical differences as well as changing pattern of cardiovascular risk profiles.
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Affiliation(s)
- J. A. HUBACEK
- Department of Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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Time for a pan-India prevention plan for cardiovascular diseases. Indian Heart J 2016; 68:252-5. [PMID: 27316472 DOI: 10.1016/j.ihj.2015.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 11/07/2015] [Accepted: 11/09/2015] [Indexed: 11/21/2022] Open
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Asghari S, Aref-Eshghi E, Godwin M, Duke P, Williamson T, Mahdavian M. Single and mixed dyslipidaemia in Canadian primary care settings: findings from the Canadian primary care sentinel surveillance network database. BMJ Open 2015; 5:e007954. [PMID: 26656980 PMCID: PMC4680009 DOI: 10.1136/bmjopen-2015-007954] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES Dyslipidaemia is a major risk factor to cardiovascular disease (CVD)--the leading cause of death worldwide. Limited data are available about the prevalence of various dyslipidaemia in Canada. The objective of this study is to describe the prevalence of various single and mixed dyslipidaemia within the Canadian population in a primary care setting. SETTING A cross-sectional study, using the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), was undertaken. PARTICIPANTS Non-pregnant adults older than 20 years were included. OUTCOME MEASURES Canadian guidelines were used to define dyslipidaemia. Descriptive statistics and multivariate regression analyses were conducted to compare the prevalence of single/mixed dyslipidaemia. RESULTS 134,074 individuals with a mean age of 59.2 (55.8% women) were identified. 34.8% of this population had no lipid abnormality, whereas 35.8%, 17.3% and 3.2% had abnormalities in one, two and three lipid components, respectively. Approximately 86% of these patients did not receive any lipid-lowering medication. Among the medication users (14%), approximately 12% were on statin monotherapy. Statin users (n=16,036) had a lower rate of low-density lipoprotein dyslipidaemia compared to non-medication users (3% vs 17%), whereas the prevalence of high-density lipoprotein (HDL) (20% vs 12%) and triglycerides (TG) (12% vs 7%) dyslipidaemia were higher in statin users. Statin users had a greater prevalence of HDL, TG and combined HDL-TG dyslipidaemia compared to non-medication users (OR 1.44, 95% CI 1.36 to 153), (OR 1.18, 95% CI 1.10 to 1.27) and (OR 1.30, 95% CI 1.22 to 1.38), respectively, (all p values<0.0001). CONCLUSIONS One of every five patients in primary care settings in Canada is suffering from mixed dyslipidaemia. The overall prevalence of dyslipidaemia remains the same between treated and untreated groups, although the type of abnormal lipid component is considerably different. Among the CVD risk factors, obesity has the greatest effect on the prevalence of all types of dyslipidaemia.
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Affiliation(s)
- Shabnam Asghari
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Erfan Aref-Eshghi
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Marshall Godwin
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Pauline Duke
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Masoud Mahdavian
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Zijlema WL, Klijs B, Stolk RP, Rosmalen JGM. (Un)Healthy in the City: Respiratory, Cardiometabolic and Mental Health Associated with Urbanity. PLoS One 2015; 10:e0143910. [PMID: 26630577 PMCID: PMC4667966 DOI: 10.1371/journal.pone.0143910] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 11/11/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Research has shown that health differences exist between urban and rural areas. Most studies conducted, however, have focused on single health outcomes and have not assessed to what extent the association of urbanity with health is explained by population composition or socioeconomic status of the area. Our aim is to investigate associations of urbanity with four different health outcomes (i.e. lung function, metabolic syndrome, depression and anxiety) and to assess whether these associations are independent of residents' characteristics and area socioeconomic status. METHODS Our study population consisted of 74,733 individuals (42% males, mean age 43.8) who were part of the baseline sample of the LifeLines Cohort Study. Health outcomes were objectively measured with spirometry, a physical examination, laboratory blood analyses, and a psychiatric interview. Using multilevel linear and logistic regression models, associations of urbanity with lung function, and prevalence of metabolic syndrome, major depressive disorder and generalized anxiety disorder were assessed. All models were sequentially adjusted for age, sex, highest education, household equivalent income, smoking, physical activity, and mean neighborhood income. RESULTS As compared with individuals living in rural areas, those in semi-urban or urban areas had a poorer lung function (β -1.62, 95% CI -2.07;-1.16), and higher prevalence of major depressive disorder (OR 1.65, 95% CI 1.35;2.00), and generalized anxiety disorder (OR 1.58, 95% CI 1.35;1.84). Prevalence of metabolic syndrome, however, was lower in urban areas (OR 0.51, 95% CI 0.44;0.59). These associations were only partly explained by differences in residents' demographic, socioeconomic and lifestyle characteristics and socioeconomic status of the areas. CONCLUSIONS Our results suggest a differential health impact of urbanity according to type of disease. Living in an urban environment appears to be beneficial for cardiometabolic health but to have a detrimental impact on respiratory function and mental health. Future research should investigate which underlying mechanisms explain the differential health impact of urbanity.
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Affiliation(s)
- Wilma L. Zijlema
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands
- * E-mail:
| | - Bart Klijs
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands
| | - Ronald P. Stolk
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands
| | - Judith G. M. Rosmalen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
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Bohm I, Lindblom C, Åbacka G, Bengs C, Hörnell A. “He just has to like ham” – The centrality of meat in home and consumer studies. Appetite 2015; 95:101-12. [DOI: 10.1016/j.appet.2015.06.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/18/2015] [Accepted: 06/23/2015] [Indexed: 01/01/2023]
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Ramnemark A, Norberg M, Pettersson-Kymmer U, Eliasson M. Adequate vitamin D levels in a Swedish population living above latitude 63°N: The 2009 Northern Sweden MONICA study. Int J Circumpolar Health 2015; 74:27963. [PMID: 28417824 PMCID: PMC4432023 DOI: 10.3402/ijch.v74.27963] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Even though vitamin D is mainly produced by exposure to sunlight, little is known regarding vitamin D levels in populations living in sub-Arctic areas with little or no daylight during winter. Objective We describe distributions of vitamin D3 and the prevalence of adequate levels in a population living above 63°N. Design We sampled 1,622 randomly selected subjects, aged 25–74 years, between January and May, 2009, as part of the Northern Sweden MONICA study (69.2% participation rate). By using HPLC, 25(OH) vitamin D3 was analysed. Levels used for definitions were deficient, D3<25 nmol/l (<10 ng/ml); insufficient, D3 25–49.9 nmol/l (10–20 ng/ml); and adequate, D3≥50 nmol/l (20 ng/ml). Results Mean (median) level of vitamin D3 was 65.2 (63.6) nmol/l in men and 71.0 (67.7) nmol/l in women. Adequate levels were found in 79.2%, more often in women (82.7%) than in men (75.6%). Only 0.7% of the population were vitamin D3–deficient but 23.1% of men and 17.1% of women had insufficient levels. Levels of vitamin D3 increased with age and insufficient status was most common among those aged 25–34 years, 41.0% in men and 22.3% in women. If subjects using vitamin D-supplementation are excluded, the population level of D3 is 1–2 nmol/l lower than in the general population across sex- and age groups. There were no differences between the northern or the southern parts, between urban or rural living or according to educational attainment. Those subjects born outside of Sweden or Finland had lower levels. Conclusion The large majority living close to the Arctic Circle in Sweden have adequate D3 levels even during the second half of the dark winter. Subjects with D3 deficiency were uncommon but insufficient levels were often found among young men.
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Affiliation(s)
- Anna Ramnemark
- a Geriatric Medicine Department of Community Medicine and Rehabilitation, Umeå University , Umeå , Sweden
| | - Margareta Norberg
- b Epidemiology and global health Department of Public Health and Clinical Medicine, Umeå University , Umeå , Sweden
| | - Ulrika Pettersson-Kymmer
- c Clinical Pharmacology Department of Pharmacology and Clinical Neuroscience, Umeå University , Umeå , Sweden
| | - Mats Eliasson
- d Department of Public Health and Clinical Medicine Sunderby Research Unit, Umeå University , Umeå , Sweden.,e Arctic Research Centre (Arcum) , Umeå University , Umeå , Sweden
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Asghari S, Aref-Eshghi E, Hurley O, Godwin M, Duke P, Williamson T, Mahdavian M. Does the Prevalence of Dyslipidemias Differ between Newfoundland and the Rest of Canada? Findings from the Electronic Medical Records of the Canadian Primary Care Sentinel Surveillance Network. Front Cardiovasc Med 2015; 2:1. [PMID: 26664873 PMCID: PMC4668842 DOI: 10.3389/fcvm.2015.00001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 01/03/2015] [Indexed: 11/16/2022] Open
Abstract
Introduction: Newfoundland and Labrador (NL) has the highest prevalence of cardiovascular disease (CVD) in Canada. Dyslipidemia is a risk factor for CVD. This study compares the prevalence of dyslipidemia in the NL population with the rest of Canada. Methods: A cross-sectional study, using data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), was undertaken. The study population included adults, excluding pregnant women, aged 20 years and older. Canadian guidelines were used for classifying dyslipidemia. Univariate and multivariate analyses were conducted to compare the lipid levels and prevalence of dyslipidemia between NL and the rest of Canada. Results: About 128,825 individuals (NL: 7,772; rest of Canada: 121,053) were identified with a mean age of 59 years (55% females). Mean levels of total cholesterol (4.96 vs. 4.93, p = 0.03), low-density lipoprotein (LDL) (3.00 vs. 2.90 mmol/L, p < 0.0001), triglyceride (1.47 vs. 1.41 mmol/L, p < 0.0001), and high-density lipoprotein (HDL) (1.29 vs. 1.39 mmol/L, p < 0.0001) were significantly different in NL compared to the rest of Canada. Dyslipidemias of LDL (29 vs. 25% p < 0.0001), HDL (38 vs. 27%, p < 0.0001), and triglyceride (29 vs. 26%, p < 0.0001) were significantly more common in NL. After adjustment for confounding variables, NL inhabitants were more likely to have dyslipidemia of total cholesterol (OR: 1.16, 95% CI: 1.10–1.23, p < 0.0001), HDL (OR: 1.52, 95% CI: 1.44–1.60, p < 0.0001), LDL (OR: 1.38, 95% CI: 1.30–1.46, p < 0.0001), and ratio (OR: 1.53, 95% CI: 1.42–1.60, p < 0.0001). Conclusion: The NL population has a significantly higher rate of dyslipidemia compared to the rest of Canada, and the mean levels of all lipid components are worse in NL. Distinct cultural and genetic features of the NL population may explain this, accounting for a higher rate of CVD in NL.
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Affiliation(s)
- Shabnam Asghari
- Memorial University of Newfoundland (MUN) , St. John's, NF , Canada
| | | | - Oliver Hurley
- Memorial University of Newfoundland (MUN) , St. John's, NF , Canada
| | - Marshall Godwin
- Memorial University of Newfoundland (MUN) , St. John's, NF , Canada
| | - Pauline Duke
- Memorial University of Newfoundland (MUN) , St. John's, NF , Canada
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