Impacto de los factores de riesgo cardiovascular en la población extremeña: aportación de la cohorte HERMEX para una estrategia preventiva

ObjectiveTo determine the population attributable fraction (PAF) of the major risk factors (RF) for the occurrence of cardiovascular disease in an Extremadura population cohort and therefore recommend priority preventive measures in health.MethodsDesign, Cohort study.LocationRepresentative population sample of a health area of Extremadura (Spain)Participants2833 individuals, from 25 to 79 years old, randomly selected and recruited between 2007 and 2009. Antecedents and clinical parameters were recorded, a follow up until December 31, 2015 were done.MeasurementsExplanatory variables: Age, sex, obesity, current smoking, arterial hypertension, diabetes mellitus (DM) and hypercholesterolemia.Outcome variableFirst event of the combined variable of myocardial infarction, angina pectoris, stroke, peripheral arterial disease and cardiovascular death. Fully adjusted hazard ratios (HR) were calculated by Cox regression. The PAFs were calculated using Levin's formula.Results2669 subjects were included, 103 had history of cardiovascular disease and 61 were lost. The follow-up was 6.9 years (IR 6.5-7.5). 134 events were recorded. Incidence rate 7.42/1,000 people-year. Adjusted HR (95% CI) were: hypertension 2.26 (1.40-3.67), hypercholesterolemia 2.23 (1.56-3.18), DM 1.79 (1.24-2.58) and current smoking 1.72 (1.11-2.69). The PAF (95% CI) were: hypertension: 31.1 (12.4-48.8), hypercholesterolemia 27.0% (14.8-40.6), smoking 18.8% (3.3–35.0) and DM 7.9% (2.6-15.2).ConclusionsHypertension confers the greatest burden of cardiovascular disease in the population of Extremadura, followed by hypercholesterolemia and smoking. These RF are priority objectives for a population-based preventive strategy.     

Prevalencia de consumo de alcohol y factores de riesgo cardiovascular en un área sanitaria de Extremadura. Estudio Hermex

ObjectivesAlcohol has been associated with a lower risk of developing cardiovascular disease. It has been our objective to determine the prevalence of use of alcohol and its association with the presence of cardiovascular risk factors (CRF).DesignCross-sectional study.SettingDon Benito-Villanueva de la Serena health area (Badajoz).ParticipantsWe selected a random sample of 25 to 79 year olds, representative of the population.MethodsWe collected a survey about the history of cardiovascular risk factors and alcohol consumption in the previous seven days. We measured blood pressure and a fasting blood sample was obtained. The association of alcohol consumption with the different CRF was studied by multivariate analysis, adjusting for different variables.ResultsA total of 2833 subjects participated, with a mean age 51.2 (SD 14.7) years and 46.5% males. We detected 36.1% (95% CI 34.4 to 37.9) of alcohol consumers. The overall prevalence and consumption medium or high risk was 63.2% and 15.2% in men, and 12.6% and 1.5% in women, respectively. In men, consumption of medium-high risk was associated with hypercholesterolemia, hypertension and smoking. In women, low-risk consumption was associated with a lower prevalence of obesity and hypertension and higher smoking.ConclusionsWe found a lower prevalence of alcohol use, especially in women, compared to the Spanish national average. The consumption of medium-high risk mainly affects men and is associated with increased cardiovascular risk. In women at low risk consumption is associated with a lower prevalence of certain CRF and increased smoking.     

Pautas de alimentación de la población gitana y la población general de España

ObjectiveThe NAOS (Nutrición, Actividad Física y Prevención de la Obesidad) strategy implemented by Spanish Ministry of Health proposes a range of healthy dietary guidelines. The objective of this article is to analyze the degree these nutritional patterns are monitored by the Roma population, compared to the rest of the population, compared to the total Spanish population.MethodsData from the 2012 National Health Survey and the 2014 Roma Health Survey were compared. Sex, age and socio-occupational scale were used as independent variables, applying a logistic regression analysis to assess their degree of influence.ResultsThere was less monitoring carried out by the Roma population of the dietary plans recommended by the Ministry of Health and differences of more of 20 percentage points were found in some of them. In both populations, age was the variable with the greatest influence, but even more so in the Roma population, while sex did not show statistical among Roma people. The follow-up data of these dietary patterns in the Roma population were lower in comparison with any of the socio-occupational groups of the rest of the population.ConclusionsThe Roma population is in a situation of inequality as regards the levels of adherence of the healthy dietary guidelines proposed by the Spanish NAOS strategy. The distance from these healthy eating habits is even greater among the younger Roma population.     

Conductas de riesgo para la salud según la ocupación en población empleada en España

ObjectiveThis study aims to analyze the variations in the prevalence of different health risk behaviors according to occupation in working population in Spain.MethodCross-sectional study with data from the Spanish National Health Survey of 2017. The analysis includes adults between 18 and 65 years with employment at the time of the survey. Health risk behaviors are obesity, physical inactivity in free time, tobacco consumption and excessive alcohol consumption. The primary explanatory variable is the occupation, using the National Classification of Occupations of 2011. Sociodemographic characteristics are gender, age, country of birth and educational level. The prevalences (P) of risk behaviors have been calculated, as well as the odd and adjusted odds ratios (aOR).ResultsThe highest figures of obesity are observed in operators of installations and machinery and assemblers (P: 20.0%; ORa: 1.26; A95%CI: 1.04–1.52). The higher level of physical inactivity during free time appears in elementary occupations (P: 83.4%; ORa: 1.70; A95%CI: 1.45–1.99). Tobacco consumption is higher in operators of installations and machinery and assemblies (P: 37.4%; ORa: 1.22; A95%CI: 1.05–1.43). Excessive alcohol consumption appears to a greater extent on skilled workers in the agricultural sector, livestock, forestry and fisheries (P: 3.9%; ORa: 1.51; A95%CI: 0.83–2.75).ConclusionsThe results indicate a greater relationship between risk behaviors for health and manual or lower-skilled occupations.     

Evolución del riesgo cardiovascular de los inmigrantes residentes en España según procedencia y años de estancia

ObjectiveTo assess whether there are differences in the immigrant population in terms of the years since their arrival in Spain and their geographical area of origin.DesignA cross-sectional study was conducted in three immigrant groups.ParticipantsThe groups selected were: a group of Latin American immigrants (298), a group of North African immigrants (130) and a group from Eastern Europe (114). A control group of 100 from a Spanish population of similar age and sex was also included.MethodsAnthropometric variables were measured, including biochemical inflammatory markers, blood pressure and cardiovascular risk estimation according to the tables of the European Societies of Hypertension and Cardiology.ResultsThe cardiovascular risk of the three groups of immigrants is similar between them (added cardiovascular risk high or very high at 5.5% in Latin Americans, 4.3% in North Africans, and 1.6% in immigrants from eastern countries), but significantly lower than the Spanish control group (28%). After 8 years in Spain, cardiovascular risk increases in the three groups of immigrants, with those from North Africa and eastern countries being comparable to the Spanish group (added cardiovascular risk high or very high of 18.5% in North Africans, and 20% in group from eastern countries). This cardiovascular risk was higher than the other groups, including the Spanish control group (Latin American immigrants 48.7% vs 28% in Spanish group).ConclusionsThe cardiovascular risk of immigrants increases over the years in Spain, with this increase being higher if they come from Latin America. This increase becomes clinically significant after the 8 years of stay in Spain.     

Prevalencia y factores de riesgo asociados a la retinopatía diabética en Santander. Norte de España

ObjetiveTo assess the prevalence and risk factors associated with diabetic retinopathy (DR) in Cantabria.Designross-sectional population based study.LocationHealth center of Cantabria.ParticiantsA random sample of 442 patients with type 2 diabetes.Main measurementsNon-mydiatric retinography, classifying them according to the International Clinical Diabetic Retinopathy Disease Severity Scale. The analyzed risk factors were: age, gender, age at diabetes onset, duration of diabetes, glycated haemoglobin levels (A1C), treatment of diabetes, blood pressure (systolic and diastolic), serum lipids concentration, body mass index, smoking status, hematocrit, pregnancy, serum vitamin D (25 OH D) levels, nephropathy and cardiovascular events.ResultsThe prevalence of DR was 8.56% (CI: 5.81-11.32): Mild non-proliferative DR: 5.07% (CI: 2.89-7.25); Moderate non-proliferative DR: 1.38% (CI: 0.17-2.60); Severe non-proliferative DR: 0.27% (CI: 0.006-1.28); proliferative DR: 1.84% (CI: 0.46-3.22). Diabetic macular oedema: 2.30% (CI: 0.77-3.83). Mean age: 70 years, mean diagnostic age: 58.97 years, mean body mass index 29.86, 78.40% patients with hypertension, 67.30% dyslipidemia and median A1C: 6.7%. A deficit of 25 (OH) D was identified in 77% of patients. In the multivariate analysis, treatment of type 2 diabetes, body mass index, duration of diabetes and metabolic control of glycaemia were identified as independent risk factors.ConclusionsThe prevalence of DR, compared with former studies, has decreased to 8.56%; this decrease is associated with the improvement in the control of modifiable risk factors. The associated independent risk factors were: treatment, body mass index, duration and control of diabetes. The variables antihypertensive treatment, cardiovascular events and nephropathy showed predictive value for DR.     

Desigualdades socioeconómicas en la salud de la población mayor en España

ObjectiveTo examine socioeconomic inequalities in health in the older population in Spain.MethodA systematic search and review of the literature published between 2000 and 2017 in English and Spanish was conducted in Social Science Citation Index, Sociology Database, Scopus, PubMed and Embase. Primary and secondary studies analysing these inequalities in Spain were included. Two researchers were responsible for the selection of the studies and the extraction of the information (first author, year of publication, region, design, population/sample, socioeconomic and health indicators used, and main results).ResultsA total of 89 articles were included, corresponding to 87 studies. Of the studies, 81.6% were cross-sectional, 88.5% included only non-institutionalised population and 35.6% were carried out at a national level. The studies analysed social inequalities in the following health indicators: functional status (n = 29), morbidity (n = 19), self-perceived health (n = 18), mental and emotional health (n = 10), cognitive status (n = 7), quality of life (n = 9), mortality (n = 15) and life expectancy (n = 2). Socioeconomic inequalities were detected in all of them, although the magnitude varied depending on the socioeconomic and health indicator used. The educational level and the ecological indexes were the indicators that detected more inequalities in health. The impact of inequalities by sex was different in functional status, morbidity, self-perceived health, mental and emotional health and mortality.ConclusionThere are socioeconomic inequalities in health among the elderly population and their magnitude varies by sex in some of the health indicators. The increase in educational level and the maintenance of sufficient pensions can be key policies that contribute to the reduction of inequalities in this population group.     

Desigualdades socioeconómicas y diferencias según sexo y edad en los factores de riesgo cardiovascular

ObjectiveTo describe the cardiovascular risk factors in a working population in the Balearic Islands and to examine whether differences by social class vary according to age and gender.MethodsA cross-sectional study was carried out in a sample of active workers aged 20-65 years in the Balearic Islands. The participants were included in the study during their annual work health assessment in 2011. The following variables were collected: occupation, social class, age, gender, height, weight, smoking, blood pressure, lipid profile, and glucose levels. Cardiovascular risk was calculated using two different equations (Framingham and REGICOR).ResultsDifferences by social class were observed for most cardiovascular risk factors. The pattern of these differences differed depending on age group and gender. Differences in obesity by social class increased with age in women but decreased in men. More differences in hypertension by social class were found among women than among men, with differences increasing with age in both genders. Significant differences by social class were found among women in lipid profile, and these differences increased with age, mainly for low levels of high-density lipoprotein-cholesterol.ConclusionsInequalities in cardiovascular risk factors by social class were higher among women than among men. Some cardiovascular risk factors such as smoking and obesity showed significant inequalities from a very early age.     

Efecto producido por la población institucionalizada en la estimación del riesgo de mortalidad en áreas pequeñas de Euskadi (España)

ObjectiveTo quantify the effect of the inclusion of the population in collective dwellings on the estimation of mortality risk in the census areas of the Basque Country (Spain) for the main causes of mortality in the period 1996-2003.MethodSmall-area ecological cross-sectional study. The main causes of mortality by sex were analyzed.ResultsWhen the general effect on all areas with a a population in collective dwellings was analyzed, hardly any noticeable effect was seen on either men or women. On the other hand, an effect was found when selecting the areas where the population in collective dwellings is more than 10% of the area's population.ConclusionsThe effect of the inclusion of the population in collective dwellings clearly seen in causes of mortality, such as dementia and Alzheimer's disease, and in chronic obstructive pulmonary disease, related to greater dependence or frailty, and therefore related to being in a nursing or elderly persons’ home, over-estimating the risk of mortality by approximately 8% and 4%, respectively, in these geographical areas.     

Desigualdades sociales en salud en población mayor: revisión de los indicadores empleados en España

ObjectiveTo identify the indicators of social position used to evaluate inequalities in health among the population aged 65 and over in Spain.MethodA systematic search of the literature published in English and Spanish since 2000 in health and social databases was carried out. Primary and secondary studies analyzing these inequalities in Spain were included. The indicators used were identified, as well as the advantages and limitations pointed out by the authors. The main findings were synthesized in a review of the literature.ResultsWe included 87 studies, described in 89 articles. The socioeconomic indicators employed were both individual and ecological. Among the former, educational level was the most analyzed socioeconomic variable (n = 73). Other individual variables used were occupation (n = 17), objective economic level (n = 16), subjective economic level (n = 4), housing and household material wealth (n = 6), relationship with work activity (n = 5), and mixed measures (n = 5). Among the ecological indicators, simple (n = 3) and complex indices (n = 7) were identified. The latter had been constructed based on several indicators, such as educational level and unemployment. Inequalities in multiple health indicators were analyzed, self-perceived health being the only indicator assessed according to all the socioeconomic indicators described.ConclusionsA wide variety of indicators is identified for the evaluation of social inequalities in health among the elderly population. There have not been sufficiently assessed from a gender perspective; this is a line of interest for future research.     

Limitaciones y recomendaciones metodológicas en las publicaciones sobre salud de la población inmigrante en España

Our objective was to describe the methodological limitations and recommendations identified by authors of original articles on immigration and health in Spain. A literature review was conducted of original articles published in Spanish or English between 1998 and 2012 combining keywords on immigration and health. A total of 311 articles were included; of these, 176 (56.6%) mentioned limitations, and 15 (4.8%) made recommendations. The most frequently mentioned limitations included the following: reduced sample sizes; internal validity and sample representativeness issues, with under- or overrepresentation of specific groups; problems of validity of the collected information and missing data mostly related to measurement tools; and absence of key variables for adjustment or stratification. Based on these results, a series of recommendations are proposed to minimise common limitations and advance the quality of scientific production on immigration and health in our setting.