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Debbarman S, Prior H, Walld R, Urquia ML. Assessing the migrant mortality advantage among foreign-born and interprovincial migrants in Manitoba, Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:441-452. [PMID: 36574203 PMCID: PMC10156882 DOI: 10.17269/s41997-022-00727-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 11/16/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Studies on mortality differentials between international immigrants and non-immigrants produced mixed results. The mortality of interprovincial migrants has been less studied. Our objectives were to compare mortality risk between international immigrants, interprovincial migrants, and long-term residents of the province of Manitoba, Canada, and identify factors associated with mortality among migrants. METHODS We conducted a retrospective matched-cohort study to examine all-cause and premature mortality of 355,194 international immigrants, interprovincial migrants, and long-term Manitoba residents (118,398 in each group) between January 1985 and March 2019 using linked administrative databases. Poisson regression was used to estimate adjusted incidence rate ratios (aIRR) with 95% confidence intervals (CI). RESULTS The all-cause mortality risk of international immigrants (2.3 per 1000 person-years) and interprovincial migrants (4.4 per 1000) was lower than that of long-term Manitobans (5.6 per 1000) (aIRR: 0.43; 95% CI: 0.42, 0.45 and aIRR: 0.81; 95% CI: 0.80, 0.84, respectively). Compared with interprovincial migrants, international immigrants showed lower death risk (aIRR: 0.50; 95% CI: 0.47, 0.52). Similar trends were observed for premature mortality. Among international immigrants, higher mortality risk was observed for refugees, those from North America and Oceania, and those of low educational attainment. Among internal migrants, those from Eastern Canada had lower mortality risk than those migrating from Ontario and Western Canada. CONCLUSION Migrants had a mortality advantage over non-migrants, being stronger for international immigrants than for interprovincial migrants. Among the two migrant groups, there was heterogeneity in the mortality risk according to migrants' characteristics.
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Affiliation(s)
- Shantanu Debbarman
- Manitoba Centre for Health Policy, Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada
- Department of Economics, Faculty of Arts, University of Manitoba, Winnipeg, MB, Canada
| | - Heather Prior
- Manitoba Centre for Health Policy, Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada
| | - Randy Walld
- Manitoba Centre for Health Policy, Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada
| | - Marcelo L Urquia
- Manitoba Centre for Health Policy, Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada.
- Department of Economics, Faculty of Arts, University of Manitoba, Winnipeg, MB, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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All-cause and cardiovascular mortality in relation to lung function in the full range of distribution across four Eastern European cohorts. Sci Rep 2022; 12:12959. [PMID: 35902678 PMCID: PMC9334616 DOI: 10.1038/s41598-022-17261-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/22/2022] [Indexed: 11/08/2022] Open
Abstract
It is unclear whether the dose–response relationship between lung function and all-cause and cardiovascular mortality in the Central and Eastern European populations differ from that reported in the Western European and American populations. We used the prospective population-based HAPIEE cohort that includes randomly selected people with a mean age of 59 ± 7.3 years from population registers in Czech, Polish, Russian and Lithuanian urban centres. The baseline survey in 2002–2005 included 36,106 persons of whom 24,944 met the inclusion criteria. Cox proportional hazards models were used to estimate the dose–response relationship between lung function defined as FEV1 divided by height cubed and all-cause and cardiovascular mortality over 11–16 years of follow-up. Mortality rate increased in a dose–response manner from highest to lower FEV1/height3 deciles. Adjusted hazard ratios (HR) of all-cause mortality for persons in the 8th best, the 5th and the worst deciles were 1.27 (95% CI 1.08‒1.49), 1.37 (1.18–1.60) and 2.15 (1.86‒2.48), respectively; for cardiovascular mortality, the respective HRs were 1.84 (1.29–2.63), 2.35 (1.67–3.28) and 3.46 (2.50‒4.78). Patterns were similar across countries, with some statistically insignificant variation. FEV1/height3 is a strong predictor of all-cause and cardiovascular mortality, across full distribution of values, including persons with preserved lung function.
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Ge X, Zhang A, Li L, Sun Q, He J, Wu Y, Tan R, Pan Y, Zhao J, Xu Y, Tang H, Gao Y. Application of machine learning tools: Potential and useful approach for the prediction of type 2 diabetes mellitus based on the gut microbiome profile. Exp Ther Med 2022; 23:305. [PMID: 35340868 PMCID: PMC8931625 DOI: 10.3892/etm.2022.11234] [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: 10/11/2021] [Accepted: 02/09/2022] [Indexed: 12/07/2022] Open
Abstract
The gut microbiota plays an important role in the regulation of the immune system and the metabolism of the host. The aim of the present study was to characterize the gut microbiota of patients with type 2 diabetes mellitus (T2DM). A total of 118 participants with newly diagnosed T2DM and 89 control subjects were recruited in the present study; six clinical parameters were collected and the quantity of 10 different types of bacteria was assessed in the fecal samples using quantitative PCR. Taking into consideration the six clinical variables and the quantity of the 10 different bacteria, 3 predictive models were established in the training set and test set, and evaluated using a confusion matrix, area under the receiver operating characteristic curve (AUC) values, sensitivity (recall), specificity, accuracy, positive predictive value and negative predictive value (npv). The abundance of Bacteroides, Eubacterium rectale and Roseburia inulinivorans was significantly lower in the T2DM group compared with the control group. However, the abundance of Enterococcus was significantly higher in the T2DM group compared with the control group. In addition, Faecalibacterium prausnitzii, Enterococcus and Roseburia inulinivorans were significantly associated with sex status while Bacteroides, Bifidobacterium, Enterococcus and Roseburia inulinivorans were significantly associated with older age. In the training set, among the three models, support vector machine (SVM) and XGboost models obtained AUC values of 0.72 and 0.70, respectively. In the test set, only SVM obtained an AUC value of 0.77, and the precision and specificity were both above 0.77, whereas the accuracy, recall and npv were above 0.60. Furthermore, Bifidobacterium, age and Roseburia inulinivorans played pivotal roles in the model. In conclusion, the SVM model exhibited the highest overall predictive power, thus the combined use of machine learning tools with gut microbiome profiling may be a promising approach for improving early prediction of T2DM in the near feature.
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Affiliation(s)
- Xiaochun Ge
- Department of Endocrinology, Affiliated Hospital of Chengde Medical University, Chengde, Hebei 067000, P.R. China
| | - Aimin Zhang
- Department of Endocrinology, Affiliated Hospital of Chengde Medical University, Chengde, Hebei 067000, P.R. China
| | - Lihui Li
- Department of Endocrinology, Affiliated Hospital of Chengde Medical University, Chengde, Hebei 067000, P.R. China
| | - Qitian Sun
- Department of Endocrinology, Affiliated Hospital of Chengde Medical University, Chengde, Hebei 067000, P.R. China
| | - Jianqiu He
- Department of Endocrinology, Affiliated Hospital of Chengde Medical University, Chengde, Hebei 067000, P.R. China
| | - Yu Wu
- Shanghai Biotecan Pharmaceuticals Co., Ltd., Shanghai 201204, P.R. China
| | - Rundong Tan
- Shanghai Biotecan Pharmaceuticals Co., Ltd., Shanghai 201204, P.R. China
| | - Yingxia Pan
- Shanghai Biotecan Pharmaceuticals Co., Ltd., Shanghai 201204, P.R. China
| | - Jiangman Zhao
- Shanghai Biotecan Pharmaceuticals Co., Ltd., Shanghai 201204, P.R. China
| | - Yue Xu
- Shanghai Biotecan Pharmaceuticals Co., Ltd., Shanghai 201204, P.R. China
| | - Hui Tang
- Shanghai Biotecan Pharmaceuticals Co., Ltd., Shanghai 201204, P.R. China
| | - Yu Gao
- Department of Endocrinology, Affiliated Hospital of Chengde Medical University, Chengde, Hebei 067000, P.R. China
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Pikala M, Burzyńska M, Maniecka-Bryła I. Standard Expected Years of Life Lost Due to Malignant Neoplasms in Poland, 2000-2014. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4898. [PMID: 31817261 PMCID: PMC6950154 DOI: 10.3390/ijerph16244898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/29/2019] [Accepted: 12/01/2019] [Indexed: 12/24/2022]
Abstract
The aim of the study was an analysis of mortality trends due to malignant neoplasms in Poland. The study material was a database, consisting of 1,367,364 death certificates of inhabitants of Poland who died during the period 2000-2014 due to malignant cancer. To calculate years of life lost, the SEYLLp index (Standard Expected Years of Life Lost per living person) was applied. We also calculated AAPC (Average Annual Percentage Change). The SEYLLp index (per 10,000 population) due to malignant neoplasms in Poland in males decreased from 586.3 in 2000 to 575.5 in 2014, whereas in females it increased from 398.6 in 2000 to 418.3 in 2014. The greatest number of lost years of life in 2014 was attributed to lung cancer (174.7 per 10,000 males and 77.3 per 10,000 females), breast cancer in females (64.5) and colorectal cancer in males (39.0). The most negative trends were observed for lung cancer in females (AAPC = 3.5%) and for colorectal cancer (AAPC = 1.8%) and prostate cancer (AAPC = 1.6%) in males. Many lost years could have been prevented by including a greater number of Polish inhabitants in screening examinations, mostly targeted at malignant neoplasm, whose incidence is closely connected with modifiable risk factors.
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Affiliation(s)
- Małgorzata Pikala
- Department of Epidemiology and Biostatistics, the Chair of Social and Preventive Medicine of the Medical University of Lodz, Żeligowskiego 7/9, 90-752 Lodz, Poland; (M.B.); (I.M.-B.)
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Abstract
Globally, the number of people with diabetes mellitus has quadrupled in the past three decades, and diabetes mellitus is the ninth major cause of death. About 1 in 11 adults worldwide now have diabetes mellitus, 90% of whom have type 2 diabetes mellitus (T2DM). Asia is a major area of the rapidly emerging T2DM global epidemic, with China and India the top two epicentres. Although genetic predisposition partly determines individual susceptibility to T2DM, an unhealthy diet and a sedentary lifestyle are important drivers of the current global epidemic; early developmental factors (such as intrauterine exposures) also have a role in susceptibility to T2DM later in life. Many cases of T2DM could be prevented with lifestyle changes, including maintaining a healthy body weight, consuming a healthy diet, staying physically active, not smoking and drinking alcohol in moderation. Most patients with T2DM have at least one complication, and cardiovascular complications are the leading cause of morbidity and mortality in these patients. This Review provides an updated view of the global epidemiology of T2DM, as well as dietary, lifestyle and other risk factors for T2DM and its complications.
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Affiliation(s)
- Yan Zheng
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, 2005 Songhu Road, Shanghai, China
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 2005 Songhu Road, Shanghai, China
| | - Sylvia H Ley
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 2005 Songhu Road, Shanghai, China
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, Massachusetts 02115, USA
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 2005 Songhu Road, Shanghai, China
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, Massachusetts 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, Massachusetts 02115, USA
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Trias-Llimós S, Kunst AE, Jasilionis D, Janssen F. The contribution of alcohol to the East-West life expectancy gap in Europe from 1990 onward. Int J Epidemiol 2017; 47:731-739. [PMID: 29228198 DOI: 10.1093/ije/dyx244] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/26/2017] [Accepted: 11/30/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Central and Eastern European (CEE) countries have lower life expectancies and higher alcohol-attributable mortality than Western European countries. We examine the contribution of alcohol consumption to mortality across Europe, and specifically to the East-West life expectancy gap from 1990 onward. METHODS We retrieved alcohol-attributable mortality rates (GBD Study 2013) and all-cause mortality rates (Human Mortality Database) by age and sex for nine CEE countries and for the EU-15 countries. We assessed country-specific potential gains in life expectancy (PGLE) by eliminating alcohol-attributable mortality using associated single decrement life tables. We decomposed the life expectancy differences between each CEE country and the EU-15 population-weighted average for 1990-2012/13 into alcohol-attributable and non-alcohol-attributable mortality. RESULTS In 2012/13, the PGLE for men and women were, respectively, 2.15 and 1.00 years in the CEE region and 0.90 and 0.44 years in the EU-15 region. The contribution of alcohol to the East-West gap in life expectancy was largest among men in Russia {2.88 years [uncertainty interval (UI): 1.57-4.06]}, Belarus [3.70 years (UI: 1.75-5.45)] and Ukraine [2.47 years (UI: 0.90-3.88)]. The relative contributions increased in most of the countries between 1990 and 2005 (on average, from 17.0% to 25.4% for men, and from 14.7% to 22.5% for women), and declined thereafter (20.2% for men and 20.5% for women in 2012/13). CONCLUSIONS Alcohol contributed substantially to the East-West life expectancy gap in Europe, and to its increase (1990-2005) and decline (2005 onward). Diminishing alcohol consumption in CEE countries to Western European levels can contribute to mortality convergence across Europe.
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Affiliation(s)
- Sergi Trias-Llimós
- Population Research Centre, University of Groningen, Groningen, The Netherlands
| | - Anton E Kunst
- Department of Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Domantas Jasilionis
- Laboratory of Demographic Data, Max Planck Institute for Demographic Research, Rostock, Germany.,Centre for Demographic Research, Vytautas Magnus University, Kaunas, Lithuania
| | - Fanny Janssen
- Population Research Centre, University of Groningen, Groningen, The Netherlands.,Netherlands Interdisciplinary Demographic Institute, The Hague, The Netherlands
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Punjani N, Power N, Vanhie JJ, Winquist E. Validation of a prediction model for avoiding post-chemotherapy retroperitoneal lymphadenectomy in patients with metastatic nonseminomatous germ cell cancer. Can Urol Assoc J 2016; 10:260-263. [PMID: 27878048 DOI: 10.5489/cuaj.3558] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Post-chemotherapy residual masses (PCRMs) may contain persistent cancer or teratoma in more than 50% of patients with metastatic non-seminomatous germ cell tumours (mNSGCTs). Retroperitoneal lymph node dissection (RPLND) is curative, but controversy exists about selection criteria for surgery. A validated prediction model by Vergouwe et al (2007) based on over 1000 patients was evaluated at our centre. METHODS mNSGCT patients treated with RPLND for PCRMs were identified from an electronic database. Typographical errors in the model were identified and corrected using their 2003 publication, but retaining the 2007 coefficients. Six clinical variables were included in the model and the calculated probability of benign tissue was compared with pathology. "Benign tissue only" was considered a positive test outcome in patients with a predicted probability of "benign tissue only" greater than 70%. RESULTS Fifty-two (52) mNSGCT patients between 1980 and 2014 were evaluable. Median age was 32 years (range 17-52) and International Germ Cell Consensus Classification (IGCCC) prognostic stages were: good 46.2%, intermediate 32.7%, and poor 21.2%. Most patients received bleomycin/etoposide/cisplatin (BEP) chemotherapy and full bilateral RPLND. Pathology showed residual cancer or teratoma in 31 patients (59.6%) and benign findings in 21 patients (40.6%). Positive and negative predictive values and accuracy were 100%, 69%, and 73%, respectively. CONCLUSIONS "Benign tissue only" was found in 100% of patients in whom this was predicted using our pre-determined criteria. This study involved a limited number of patients, but confirms the potential value of the Vergouwe et al model. Routine use of this prediction model in clinical practice should be tested for mNSGCT patients with PCRMs.
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Affiliation(s)
- Nahid Punjani
- Division of Urology, Western University and London Health Sciences Centre, London, ON, Canada
| | - Nicholas Power
- Division of Urology, Western University and London Health Sciences Centre, London, ON, Canada
| | - James J Vanhie
- Division of Medical Oncology, Western University and London Health Sciences Centre, London, ON, Canada
| | - Eric Winquist
- Division of Medical Oncology, Western University and London Health Sciences Centre, London, ON, Canada
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Cybulsky M, Cook S, Kontsevaya AV, Vasiljev M, Leon DA. Pharmacological treatment of hypertension and hyperlipidemia in Izhevsk, Russia. BMC Cardiovasc Disord 2016; 16:122. [PMID: 27255373 PMCID: PMC4891885 DOI: 10.1186/s12872-016-0300-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 05/25/2016] [Indexed: 11/19/2022] Open
Abstract
Background Cardiovascular disease (CVD) is the leading cause of death in Russia. Hypertension and hyperlipidemia are important risk factors for CVD that are modifiable by pharmacological treatment and life-style changes. We aimed to characterize the extent of the problem in a typical Russian city by examining the prevalence, treatment and control rates of hypertension and hyperlipidemia and investigating whether the specific pharmacological regimes used were comparable with guidelines from a country with much lower CVD rates. Methods The Izhevsk Family Study II included a cross-sectional survey of a population sample of 1068 men, aged 25–60 years conducted in Izhevsk, Russia (2008–2009). Blood pressure and total cholesterol were measured and self-reported medication use was recorded by a clinician. We compared drug treatments with the Russian and Canadian treatment guidelines for hypertension and hyperlipidemia. Results The prevalence of hypertension was 61 % (age-standardised prevalence 51 %), with 66 % of those with hypertension aware of their diagnosis and 50 % of those aware taking treatment. 17 % of those taking treatment achieved blood pressure control. The majority (59 %) of those taking treatment were not doing so regularly. Prevalence of hyperlipidemia was 45 % (age-standardised prevalence 40 %), however less than 2 % of those with hyperlipidemia were taking any treatment. Types of lipid-lowering and anti-hypertensive medications prescribed were broadly in line with Russian and Canadian guidelines. Conclusion The prevalence of hypertension and hyperlipidemia is high in Izhevsk while the proportion of those treated and attaining treatment targets is very low. Prescribed medications were concurrent with those in Canada, but adherence is a major issue.
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Affiliation(s)
| | - Sarah Cook
- Department of Non Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | | | | | - David A Leon
- Department of Non Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Arctic University of Norway, UiT, Tromsø, Norway
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Todd MA, Shkolnikov VM, Goldman N. Why are well-educated Muscovites more likely to survive? Understanding the biological pathways. Soc Sci Med 2016; 157:138-47. [PMID: 27085072 PMCID: PMC5282593 DOI: 10.1016/j.socscimed.2016.02.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/23/2016] [Accepted: 02/25/2016] [Indexed: 12/25/2022]
Abstract
There are large socioeconomic disparities in adult mortality in Russia, although the biological mechanisms are not well understood. With data from the study of Stress, Aging, and Health in Russia (SAHR), we use Gompertz hazard models to assess the relationship between educational attainment and mortality among older adults in Moscow and to evaluate biomarkers associated with inflammation, neuroendocrine function, heart rate variability, and clinical cardiovascular and metabolic risk as potential mediators of that relationship. We do this by assessing the extent to which the addition of biomarker variables into hazard models of mortality attenuates the association between educational attainment and mortality. We find that an additional year of education is associated with about 5% lower risk of age-specific all-cause and cardiovascular mortality. Inflammation biomarkers are best able to account for this relationship, explaining 25% of the education-all-cause mortality association, and 35% of the education-cardiovascular mortality association. Clinical markers perform next best, accounting for 13% and 23% of the relationship between education and all-cause and cardiovascular mortality, respectively. Although heart rate biomarkers are strongly associated with subsequent mortality, they explain very little of the education-mortality link. Neuroendocrine biomarkers fail to account for any portion of the link. These findings suggest that inflammation may be important for understanding mortality disparities by socioeconomic status.
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Affiliation(s)
- Megan A Todd
- Office of Population Research and the Woodrow Wilson School of Public and International Affairs, Princeton University, USA.
| | - Vladimir M Shkolnikov
- Max Planck Institute for Demographic Research, Konrad-Zuse-Str., 1, Rostock, 18057, Germany; New Economic School, ul. Novaya, 100A, Moscow, 143026, Skolkovo, Russia.
| | - Noreen Goldman
- Office of Population Research and the Woodrow Wilson School of Public and International Affairs, Princeton University, Wallace Hall, Princeton, NJ, 08544, USA.
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Does the consumption of fruits and vegetables differ between Eastern and Western European populations? Systematic review of cross-national studies. ACTA ACUST UNITED AC 2015; 73:29. [PMID: 26078867 PMCID: PMC4466869 DOI: 10.1186/s13690-015-0078-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 05/05/2015] [Indexed: 12/07/2022]
Abstract
BACKGROUND Difference in fruit and vegetable consumption has been suggested as a possible reason for the large gap in cardiovascular disease (CVD) mortality rates between Eastern and Western European populations. However, individual-level dietary data which allow direct comparison across the two regions are rare. In this systematic review we aimed to answer the question whether cross-national studies with comparable individual-level dietary data reveal any systematic differences in fruit and vegetable consumption between populations in Central and Eastern Europe (CEE) and the Former Soviet Union (FSU) compared to Western Europe (WE). METHODS Studies were identified by electronic search of MEDLINE, EMBASE and Web of Science databases from inception to September 2014, and hand search. Studies which reported data on fruit, vegetable consumption or carotene and vitamin C intake or tissue concentrations of adult participants from both CEE/FSU and WE countries were considered for inclusion. Quality of the included studies was assessed by a modified STROBE statement. Power calculation was performed to determine the statistical significance of the comparison results. RESULTS Twenty-two studies fulfilled the inclusion criteria. Fruit consumption was found to be consistently lower in CEE/FSU participants compared to Western Europeans. Results on vegetable intake were less unambiguous. Antioxidant studies indicated lower concentration of beta-carotene in CEE/FSU subjects, but the results for vitamin C were not consistent. CONCLUSION This systematic review suggests that populations in CEE and FSU consume less fruit than Western Europeans. The difference in the consumption of fruit may contribute to the CVD gap between the two regions.
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Stefler D, Pikhart H, Jankovic N, Kubinova R, Pajak A, Malyutina S, Simonova G, Feskens EJM, Peasey A, Bobak M. Healthy diet indicator and mortality in Eastern European populations: prospective evidence from the HAPIEE cohort. Eur J Clin Nutr 2014; 68:1346-1352. [PMID: 25028084 PMCID: PMC4209172 DOI: 10.1038/ejcn.2014.134] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 05/12/2014] [Accepted: 06/05/2014] [Indexed: 11/26/2022]
Abstract
Background/Objectives Unhealthy diet has been proposed as one of the main reasons for the high mortality in Central and Eastern Europe (CEE) and the former Soviet Union (FSU) but individual-level effects of dietary habits on health in the region are sparse. We examined the associations between the healthy diet indicator (HDI) and all-cause and cause-specific mortality in three CEE/FSU populations. Subjects/Methods Dietary intakes of foods and nutrients, assessed by food frequency questionnaire (FFQ) in the Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) cohort study, were used to construct the HDI which follows the WHO 2003 dietary recommendations. Among 18 559 eligible adult participants (age range: 45-69 years) without history of major chronic diseases at baseline, 1 209 deaths occurred over mean follow up of 7 years. The association between HDI and mortality was estimated by Cox regression. Results After adjusting for covariates, HDI was inversely and statistically significantly associated with cardiovascular disease (CVD) and coronary heart disease (CHD) mortality, but not with other cause-specific and all-cause mortality in the pooled sample. Hazard ratios per one standard deviation (SD) increase in HDI score were 0.95 (95%CI 0.89-1.00, p=0.068), 0.90 (0.81-0.99, p=0.030) and 0.85 (0.74-0.97, p=0.018) for all-cause, CVD and CHD mortality, respectively. Population attributable risk fractions for low HDI were 2.9% for all-cause, 14.2% for CVD and 10.7% for CHD mortality. Conclusions These findings support the hypothesis that unhealthy diet has played a role in the high CVD mortality in Eastern Europe.
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Affiliation(s)
- Denes Stefler
- Department of Epidemiology and Public Health, University College London, UK
| | - Hynek Pikhart
- Department of Epidemiology and Public Health, University College London, UK
| | | | | | | | - Sofia Malyutina
- Institute of Internal and Preventive Medicine, Siberian Branch of the Russian Academy of Medical Sciences, Novosibirsk, Russia.,Novosibirsk State Medical University, Novosibirsk, Russia
| | - Galina Simonova
- Institute of Internal and Preventive Medicine, Siberian Branch of the Russian Academy of Medical Sciences, Novosibirsk, Russia
| | | | - Anne Peasey
- Department of Epidemiology and Public Health, University College London, UK
| | - Martin Bobak
- Department of Epidemiology and Public Health, University College London, UK
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12
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Müller-Nordhorn J, Holmberg C, Dokova KG, Milevska-Kostova N, Chicin G, Ulrichs T, Rechel B, Willich SN, Powles J, Tinnemann P. Perceived challenges to public health in Central and Eastern Europe: a qualitative analysis. BMC Public Health 2012; 12:311. [PMID: 22537389 PMCID: PMC3370990 DOI: 10.1186/1471-2458-12-311] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 04/26/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There is a major gradient in burden of disease between Central and Eastern Europe compared to Western Europe. Many of the underlying causes and risk factors are amenable to public health interventions. The purpose of the study was to explore perceptions of public health experts from Central and Eastern European countries on public health challenges in their countries. METHODS We invited 179 public health experts from Central and Eastern European countries to a 2-day workshop in Berlin, Germany. A total of 25 public health experts from 14 countries participated in May 2008. The workshop was structured into 8 sessions of 1.5 hours each, with the topic areas covering coronary heart disease, stroke, prevention, obesity, alcohol, tobacco, tuberculosis, and HIV/AIDS. The workshop was recorded and the proceedings transcribed verbatim. The transcripts were entered into atlas.ti for content analysis and coded according to the session headings. After analysis of the content of each session discussion, a re-coding of the discussions took place based on the themes that emerged from the analysis. RESULTS Themes discussed recurred across disease entities and sessions. Major themes were the relationship between clinical medicine and public health, the need for public health funding, and the problems of proving the effectiveness of disease prevention. Areas for action identified included the need to engage with the public, to create a better scientific basis for public health interventions, to identify "best practices" of disease prevention, and to implement registries/surveillance instruments. The need for improved data collection was seen throughout all areas discussed, as was the need to harmonize data across countries. CONCLUSIONS To reduce the burden of disease across Europe, closer collaboration of countries across Europe seems important in order to learn from each other. A more credible scientific basis for effective public health interventions is urgently needed. The monitoring of health trends is crucial to evaluate the impact of public health programmes.
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Affiliation(s)
- Jacqueline Müller-Nordhorn
- Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin, Germany
- Berlin School of Public Health, Charité University Medical Center, Seestr. 73, 13347, Berlin, Germany
| | - Christine Holmberg
- Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin, Germany
- Berlin School of Public Health, Charité University Medical Center, Seestr. 73, 13347, Berlin, Germany
| | - Klara G Dokova
- Department of Social Medicine and Health Care Organization, Faculty of Public Health, Medical University of Varna, Varna, Bulgaria
| | | | - Gratiana Chicin
- National Institute for Public Health, Regional Center Timisoara, Timisoara, Romania
| | - Timo Ulrichs
- Koch-Metchnikov-Forum, Federal Ministry of Health, Berlin, Germany
| | - Bernd Rechel
- London School of Hygiene & Tropical Medicine, London, UK
| | - Stefan N Willich
- Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin, Germany
| | - John Powles
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Peter Tinnemann
- Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin, Germany
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Zatonski WA, Bhala N. Changing trends of diseases in Eastern Europe: closing the gap. Public Health 2012; 126:248-252. [PMID: 22325674 DOI: 10.1016/j.puhe.2011.11.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2011] [Indexed: 01/16/2023]
Abstract
One of the greatest challenges in Europe at the beginning of the 21st Century is the wide east-west health gap. In 2008, the difference in life expectancy between men in some Western European countries and Russia was 20 years. Whilst trends for life expectancy at birth have improved in many areas around the world, those for Russia, as well as those for some other former Soviet Union countries, have fluctuated greatly and have not shown signs of growth since the middle of the 20th Century. This problem is most acute in Russia and former Soviet Union countries, but is also far from being solved in the states that have made significant progress since 1990 and joined the European Union in the 21st Century. One of the priorities of the Polish presidency of the European Union, which began in July 2011, is the call for a European solidarity for health that could help to close the health gap dividing Europe.
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Affiliation(s)
- W A Zatonski
- Department of Cancer Epidemiology and Prevention, M. Sklodowska-Curie Memorial, Cancer Centre and Institute of Oncology, Warsaw, Poland; European Health Inequalities Observatory, Institute of Rural Health, Lublin, Poland.
| | - N Bhala
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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Bertuccio P, Levi F, Lucchini F, Chatenoud L, Bosetti C, Negri E, La Vecchia C. Coronary heart disease and cerebrovascular disease mortality in young adults: recent trends in Europe. ACTA ACUST UNITED AC 2011; 18:627-34. [PMID: 21521726 DOI: 10.1177/1741826710389393] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Over the last two decades, mortality from coronary heart disease (CHD) and cerebrovascular disease (CVD) declined by about 30% in the European Union (EU). DESIGN We analyzed trends in CHD (X ICD codes: I20-I25) and CVD (X ICD codes: I60-I69) mortality in young adults (age 35-44 years) in the EU as a whole and in 12 selected European countries, over the period 1980-2007. METHODS Data were derived from the World Health Organization mortality database. With joinpoint regression analysis, we identified significant changes in trends and estimated average annual percent changes (AAPC). RESULTS CHD mortality rates at ages 35-44 years have decreased in both sexes since the 1980s for most countries, except for Russia (130/100,000 men and 24/100,000 women, in 2005-7). The lowest rates (around 9/100,000 men, 2/100,000 women) were in France, Italy and Sweden. In men, the steepest declines in mortality were in the Czech Republic (AAPC = -6.1%), the Netherlands (-5.2%), Poland (-4.5%), and England and Wales (-4.5%). Patterns were similar in women, though with appreciably lower rates. The AAPC in the EU was -3.3% for men (rate = 16.6/100,000 in 2005-7) and -2.1% for women (rate = 3.5/100,000). For CVD, Russian rates in 2005-7 were 40/100,000 men and 16/100,000 women, 5 to 10-fold higher than in most western European countries. The steepest declines were in the Czech Republic and Italy for men, in Sweden and the Czech Republic for women. The AAPC in the EU was -2.5% in both sexes, with steeper declines after the mid-late 1990s (rates = 6.4/100,000 men and 4.3/100,000 women in 2005-7). CONCLUSIONS CHD and CVD mortality steadily declined in Europe, except in Russia, whose rates were 10 to 15-fold higher than those of France, Italy or Sweden. Hungary and Poland, and also Scotland, where CHD trends were less favourable than in other western European countries, also emerge as priorities for preventive interventions.
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Affiliation(s)
- Paola Bertuccio
- Department of Epidemiology, Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy.
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Scott KW, Powles J, Thomas H, Rechel B. Perceived barriers to the development of modern public health in Bulgaria: a qualitative study. Int J Public Health 2010; 56:191-9. [PMID: 20379759 DOI: 10.1007/s00038-010-0140-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2009] [Revised: 03/21/2010] [Accepted: 03/25/2010] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES This qualitative investigation documents Bulgarian perspectives on public health following its accession to the European Union (EU) and explores perceived obstacles to the modernization of public health sciences to more effectively address the country's high rates of premature avoidable mortality. METHODS 28 semi-structured interviews were conducted throughout Bulgaria in April 2007 with Bulgarian academics, clinicians, policymakers and students in Sofia, Varna and Pleven. Full transcripts were subjected to formal thematic analysis. RESULTS Respondents identified various barriers to the development and modernization to public health infrastructures in Bulgaria that were classified by four key interlinked themes: (1) institutional and political, (2) financial, (3) dearth of local epidemiological studies, and (4) insufficient public health capacity. CONCLUSIONS This study is the first to explore specific perspectives and beliefs regarding barriers to the development, modernization, and utilization of public health sciences in Bulgaria. Although the reorientation and strengthening of public health institutions are unlikely to proceed without resistance, optimism for improvement in this field exists now that Bulgaria has joined the EU.
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Affiliation(s)
- Kirstin Woody Scott
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, University Forvie Site, Cambridge, CB2 2SR, UK.
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Jankowski P, Bilo G, Kawecka-Jaszcz K. The pulsatile component of blood pressure – Its role in the pathogenesis of atherosclerosis. Blood Press 2009; 16:238-45. [PMID: 17852092 DOI: 10.1080/08037050701428166] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Pulse pressure (PP) is traditionally believed to increase cardiovascular risk because of an increase in afterload leading to left ventricular hypertrophy. It has also been emphasized that low diastolic blood pressure, being in part responsible for high PP, leads to an impairment of myocardial perfusion with all its adverse consequences. More recently, however, a direct role of pulsatile blood pressure changes in the pathogenesis of atherosclerosis and its complications has become better known. Experimental studies indicate that there is a cause-and-effect type of relationship between the pulsatile component of blood pressure and atherosclerotic process. A significant relationship between the parameters of the pulsatile blood pressure component and the extent of coronary atherosclerosis was also demonstrated. Currently the presence of a bidirectional link between atherosclerosis and PP is commonly postulated, meaning that an increased PP may be both a cause and an effect of atherosclerosis. This may result in a vicious circle wherein the pulsatile blood pressure component induces/enhances the development of atherosclerosis, which in its turn reduces the arterial compliance and enhances pulse wave reflection, thereby leading to an increase in PP. Currently new drug classes are being investigated, which might reduce the pulsatile blood pressure component without changing mean blood pressure level. Their clinical usefulness should become known over the next few years.
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Affiliation(s)
- Piotr Jankowski
- I Department of Cardiology and Hypertension, Collegium Medicum Jagiellonian University, Kraków, Poland.
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Briggs DJ. A framework for integrated environmental health impact assessment of systemic risks. Environ Health 2008; 7:61. [PMID: 19038020 PMCID: PMC2621147 DOI: 10.1186/1476-069x-7-61] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Accepted: 11/27/2008] [Indexed: 05/19/2023]
Abstract
Traditional methods of risk assessment have provided good service in support of policy, mainly in relation to standard setting and regulation of hazardous chemicals or practices. In recent years, however, it has become apparent that many of the risks facing society are systemic in nature - complex risks, set within wider social, economic and environmental contexts. Reflecting this, policy-making too has become more wide-ranging in scope, more collaborative and more precautionary in approach. In order to inform such policies, more integrated methods of assessment are needed. Based on work undertaken in two large EU-funded projects (INTARESE and HEIMTSA), this paper reviews the range of approaches to assessment now in used, proposes a framework for integrated environmental health impact assessment (both as a basis for bringing together and choosing between different methods of assessment, and extending these to more complex problems), and discusses some of the challenges involved in conducting integrated assessments to support policy. Integrated environmental health impact assessment is defined as a means of assessing health-related problems deriving from the environment, and health-related impacts of policies and other interventions that affect the environment, in ways that take account of the complexities, interdependencies and uncertainties of the real world. As such, it depends heavily on how issues are selected and framed, and implies the involvement of stakeholders both in issue-framing and design of the assessment, and to help interpret and evaluate the results. It is also a comparative process, which involves evaluating and comparing different scenarios. It consequently requires the ability to model the way in which the influences of exogenous factors, such as policies or other interventions, feed through the environment to affect health. Major challenges thus arise. Chief amongst these are the difficulties in ensuring effective stakeholder participation, in dealing with the multicausal and non-linear nature of many of the relationships between environment and health, and in taking account of adaptive and behavioural changes that characterise the systems concerned.
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Affiliation(s)
- David J Briggs
- Department of Environmental Epidemiology and Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
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Mackenbach JP, Stirbu I, Roskam AJR, Schaap MM, Menvielle G, Leinsalu M, Kunst AE. Socioeconomic inequalities in health in 22 European countries. N Engl J Med 2008; 358:2468-81. [PMID: 18525043 DOI: 10.1056/nejmsa0707519] [Citation(s) in RCA: 1880] [Impact Index Per Article: 117.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Comparisons among countries can help to identify opportunities for the reduction of inequalities in health. We compared the magnitude of inequalities in mortality and self-assessed health among 22 countries in all parts of Europe. METHODS We obtained data on mortality according to education level and occupational class from census-based mortality studies. Deaths were classified according to cause, including common causes, such as cardiovascular disease and cancer; causes related to smoking; causes related to alcohol use; and causes amenable to medical intervention, such as tuberculosis and hypertension. Data on self-assessed health, smoking, and obesity according to education and income were obtained from health or multipurpose surveys. For each country, the association between socioeconomic status and health outcomes was measured with the use of regression-based inequality indexes. RESULTS In almost all countries, the rates of death and poorer self-assessments of health were substantially higher in groups of lower socioeconomic status, but the magnitude of the inequalities between groups of higher and lower socioeconomic status was much larger in some countries than in others. Inequalities in mortality were small in some southern European countries and very large in most countries in the eastern and Baltic regions. These variations among countries appeared to be attributable in part to causes of death related to smoking or alcohol use or amenable to medical intervention. The magnitude of inequalities in self-assessed health also varied substantially among countries, but in a different pattern. CONCLUSIONS We observed variation across Europe in the magnitude of inequalities in health associated with socioeconomic status. These inequalities might be reduced by improving educational opportunities, income distribution, health-related behavior, or access to health care.
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Affiliation(s)
- Johan P Mackenbach
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Abstract
Injuries cause 9% of deaths and 14% of ill health in the WHO European Region. This problem is neglected; injuries are often seen as part of everyday life. However, although western Europe has good safety levels, death and disability from injury are rising in eastern Europe. People in low-to-middle-income countries in the Region are 3.6 times more likely to die from injuries than those in high-income countries. Economic and political change have led to unemployment, income inequalities, increased traffic, reduced restrictions on alcohol, and loss of social support. Risks such as movement of vulnerable populations and transfer of lifestyles and products between countries also need attention. In many countries, the public-health response has been inadequate, yet the cost is devastating to individuals and health-service budgets. More than half a million lives could be saved annually in the Region if recent knowledge could be used to prevent injuries and thus redress social injustice in this area.
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Affiliation(s)
- Dinesh Sethi
- Accidents, Transport and Health, WHO European Centre for Environment and Health, Special Programme on Health and Environment, WHO Regional Office for Europe, Rome 00187, Italy.
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Pilav A, Nissinen A, Haukkala A, Niksic D, Laatikainen T. Cardiovascular risk factors in the Federation of Bosnia and Herzegovina. Eur J Public Health 2006; 17:75-9. [PMID: 16698884 DOI: 10.1093/eurpub/ckl066] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Federation of Bosnia and Herzegovina (FBiH) has high cardiovascular disease mortality as other countries in Eastern Europe and situation has even deteriorated in the post war period. Reliable information on risk factor levels and patterns needed in prevention planning and disease management has been lacking. METHODS A cross sectional population survey was conducted in the FBiH in autumn 2002. A random sample of population, aged 25-64 years, was taken using a three stage stratified sampling methodology. Altogether, 2750 persons participated in the survey (1121 men and 1629 women). The survey was done according to internationally established standards and protocols. RESULTS The mean systolic blood pressure was 132 mmHg among men and 135 mmHg among women. The mean diastolic blood pressure was 84 mmHg in both genders. Almost 40% of the participants were recognized as hypertensive (blood pressure level over 140/90 mmHg). The prevalence of hypertension among men was 36% and among women 45%. The mean Body Mass Index (BMI) was 26.5 kg/m(2) among males and 27.0 kg/m(2) among females. About 75% of both men and women were overweight (BMI > 25 kg/m(2)) and 16% of men and 20% of women were obese (BMI > 30 kg/m(2)). About 50% of men and 30% of women reported to be daily smokers. CONCLUSIONS As a whole the non-communicable disease risk factor levels in the FBiH seems to be relatively high. The data can be utilized in health promotion planning and as a baseline for future monitoring activities with possibility of international comparison of results.
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Affiliation(s)
- Aida Pilav
- Department of Health statistics and informatics, Federal Public Health Institute Sarajevo, Bosnia and Herzegovina.
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