Gender differences in asthma prevalence: Variations with socioeconomic disadvantage

Background and objective: Socioeconomic inequalities in health have been shown to vary for different diseases and by gender. This study aimed to examine gender differences in associations between asthma and socioeconomic disadvantage. Methods: Socioeconomic variables were assessed among men and women in the North West Adelaide Health Study, a representative population cohort (n = 4060) aged 18 years and over in metropolitan South Australia. Asthma was determined from spirometry and self‐reported doctor diagnosis. Results: The prevalence of asthma was 12.0% (95% CI: 11.1–13.1), and was significantly higher among women (13.5%) than men (10.5%). For participants aged 18–64 years a higher prevalence of asthma was associated with an education level of secondary school or lower, or not being in the paid labour force among men, and with a gross annual household income of $20 000 or less among women. Among socioeconomically advantaged groups, the prevalence of asthma was significantly higher among women than men. Conclusions: Socioeconomic disadvantage was associated with higher asthma prevalence, although this varied by gender depending on the indicator of socioeconomic position used. Men with low education or those not employed in the paid labour force had higher asthma prevalence than more socioeconomically advantaged men. Women with low income had higher asthma prevalence than those with higher income. Among all socioeconomically advantaged groups, and also the low‐income group, women experienced a higher prevalence of asthma than men.     

Ethnic differences in bowel cancer awareness: findings from a pharmacy-based community survey

BackgroundWe used London-based multilingual community pharmacies to better understand ethnic inequalities in levels of bowel cancer awareness.MethodsWe invited 206 community pharmacies for this study through the Middlesex Group of Local Pharmaceutical Committees. Participating pharmacies interviewed customers (aged 60 years or older) using a modified version of the Bowel Cancer Awareness Measure. Awareness was divided into symptom, risk factor, and screening awareness. Variation in risk factor and symptom awareness were assessed using stepwise linear regression, whereas variation in screening awareness was assessed using logistic regression. The fully-adjusted model controlled for main spoken language, age, gender, and pharmacy postcode-based index of multiple deprivation rank. No ethical monitoring was required due to complete anonymity of responders and implied consent by return of questionnaire.Findings40 community pharmacies (19% of those invited) interviewed 913 customers. There was no statistically significant difference in area-level deprivation between participating and non-participating community pharmacies (p=0·50). To minimise confounding, individuals who reported a history of bowel cancer were excluded from the analysis (n=49; 5%) leaving 864 participants (95% of the full sample). Among these 864 participants, the sample comprised 578 (67%) English speakers, 412 (48%) women, 406 (47%) men, 406 (47%)white-British, 228 (26%) Indian, 43 (5%) white-Irish, 39 (5%) black Caribbean, 23 (3%) Pakistani, 21 (2%) black African, 16 (2%) of other white ethnicity, and 29 (3%) of other ethnicity. At the univariate level, ethnicity was associated with symptom awareness (p=0·0021) and screening awareness (p<0·0001), but not risk factor awareness (p=0·41). In a fully-adjusted model, screening awareness was statistically significantly lower among black African (adjusted odds ratio 0·37 [95% CI 0·17–0·80; p=0·012), black Caribbean (0·28 [0·10–0·83]; p=0·022), and participants from other ethnic groups (0·19 [0·07–0·48]; p=0·0014), compared with white-British participants. However, symptom awareness was no longer associated with ethnicity. Screening awareness was also higher in pharmacies situated in more affluent areas (7·83 [2·14–28·65]; p=0·002) even after adjusting for other demographics. There was however no association between levels of area-level deprivation and symptom or risk awareness.InterpretationOverall, administering bowel cancer awareness measure was feasible. Although participation of community pharmacies was low, the number of surveys completed was substantial and there was little evidence to suggest selection bias in terms of deprivation. The association between ethnicity and screening awareness was independent of language, which means that unlike symptom awareness, campaigns trying to reduce inequalities in awareness of screening programmes cannot just rely on providing materials in people's native language. Instead, academics and community outreach workers should work with community pharmacies and their customers to co-create materials to improve awareness of the bowel cancer screening programme. Future Bowel Cancer Awareness Measure surveys would also benefit from larger sample sizes among individual ethnic groups and the least and most deprived.FundingNorgine, St Mark's Bowel Cancer Screening Centre.     

Gender differences in tuberculosis: a prevalence survey done in Bangladesh.

SETTING: Bangladesh national tuberculosis control programme districts supported by the Damien Foundation (population 18 million). OBJECTIVE: To determine whether the observed gender difference is epidemiologically true or whether it is due to accessibility barriers for women. DESIGN: Two-stage random sampling population survey. People were interviewed by teams composed of one male and one female volunteer about the presence of symptoms suggestive of tuberculosis. One early morning sputum specimen of all thus identified tuberculosis suspects was examined by Ziehl-Neelsen technique. RESULTS: A total of 266189 people were surveyed, among whom 223 936 (84.1%) could be interviewed. This led to the identification of 7001 tuberculosis suspects (2406 females and 4595 males) and 64 confirmed TB cases (16 females and 48 males). The female/male ratio (0.33:1) of cases found during the survey was not higher than that observed through routine diagnosis (0.42:1). The routine case-notification rate of sputum-positive cases during 2000 was about twice the rate observed during the survey (44.3 vs. 24.0 per 100 000 population). CONCLUSIONS: The gender difference observed in routine tuberculosis diagnosis is real, and is not due to lesser accessibility of women to the health services. The routine notification rate compares favourably with the detection of previously unknown cases found during the survey.     

作者单位：武汉大学人民医院心内二科,武汉,430060#$NL通讯作者：陈芳,S本科,主任护师,主要从事心电生理与心血管病护理的研究S

目的 调查湖北地区高血压患病率的性别差异,以期为高血压疾病防治策略提供循证科学依据。方法 2013年2月至2013年10月在湖北省咸宁咸安区、孝感应城县,采用分层多阶段随机抽样方法调查了4199名15岁以上当地居民。通过调查问卷及体格检查收集调查对象个人基本情况、身高、体重等所需要的资料。结果 男性及女性高血压患病率的最高峰均为75～,当地居民高血压患病率从25～起随着年龄的上升而增高,其中男性高血压患病率从25～起随着年龄的上升而增高,女性高血压患病率随着年龄的上升而增高;当地居民中,收缩压均值水平从25～起随着年龄的上升而增加,收缩压均值水平的高峰在75～,舒张压均值水平的高峰在45～。男性收缩压均值为124.54±15.25,舒张压均值为74.23±9.71;女性收缩压均值为121.29±17.48,舒张压均值为71.73±9.55。各年龄段间舒张压均值水平有统计学差异(P＜0.05)。就收缩压水平,男性及女性之间(F＝41.143,P<0.05),各年龄组之间(F＝129.021,P<0.05)均有统计学差异;就舒张压水平,男性及女性之间(F＝70.689,P<0.05),各年龄组之间(F＝16.641,P<0.05)均有统计学差异。结论 湖北地区男性及女性高血压患病率有统计学差异(P<0.05),从35～起到75～男性及女性高血压患病率有统计学差异(P<0.05)。     

Gender differences in the treatment of hypertension: a community based study in Porto.

OBJECTIVES: To describe the use of antihypertensive drugs in a random sample of adults living in Porto, Portugal, and to identify gender differences in the treatment of hypertension. DESIGN: Observational, cross-sectional. PARTICIPANTS AND METHODS: Nine hundred and fifty-nine participants over 39 years of age, living in Porto, were selected by random digit dialing. For each subject, socioeconomic characterization, family and personal medical history, and information on antihypertensive treatment were obtained through a questionnaire. Blood pressure was measured on a single occasion, and a fasting blood sample was collected. Gender differences in the treatment of arterial hypertension and number and type of drugs were evaluated through the calculation of female:male proportion ratios and 95% confidence intervals (95% CI). RESULTS: Hypertension treatment was more frequent in women than in men (proportion ratio 1.40, 95% CI 1.15-1.72), although no differences were observed among hypertensives aware of their condition (proportion ratio 1.07, 95% CI 0.93-1.22). The female:male proportion ratios of treatment with one drug, fixed combination therapy and free combination therapy were 1.13 (95% CI 0.94-1.36), 0.83 (95% CI 0.34-2.01) and 0.76 (95% CI 0.49-1.19), respectively. In subjects treated with one drug the use of ACE inhibitors/AT-II antagonists was more frequent in men (proportion ratio 0.68, 95% IC 0.46-1.01) and treatment with diuretics higher in women (proportion ratio 1.83, 95% CI 1.04-3.23). In participants treated with combination therapy, ACE inhibitors/AT-II antagonists and diuretics were more frequently used by women and calcium channel blockers and beta-blockers by men (female:male proportion ratios were 1.27, 95% CI 0.96-1.68, 1.24, 95% CI 0.94-1.64, 0.61, 95% CI 0.37-1.02 and 0.74, 95% CI 0.31-1.79, respectively). CONCLUSIONS: Arterial hypertension tended to be more frequently treated among women and different therapeutic options were found according to gender. Gender differences in the awareness of hypertension, sexual specificity of the activity of antihypertensive drugs, and comorbidity may play a role in gender inequalities in the treatment of hypertension in Portugal.     

Gender differences in FOBT use: evidence from a large German survey

We examined prevalence and correlates of fecal occult blood testing (FOBT) uptake in a sample of men and women aged 50 to 70 years without a personal history of cancer (n=15,810). The data was collected in 2004 through the Health Care Access Panel (HCAP), a nationally generalizable survey of German households. A pronounced gender difference in FOBT use emerged. Women reported regular use more often, while men reported irregular use with a higher frequency. Nearly every third men (29.6%), compared to 17.5% of the women had never made use of FOBT. The influence of socioeconomic factors on FOBT uptake was negligible. Family history of cancer was significantly associated with FOBT but the effect was very small. Use of medical checkups and physician recommendation were the most important predictors of FOBT use in men and women. Gender differences in use of medical checkups and physician recommendation to undergo an examination for the early detection of cancer partly mediated the gender differences in FOBT use.     

Epilepsy prevalence in rural Zambia: a door-to-door survey

OBJECTIVES: To identify people with epilepsy (PWE) in our Zambian catchment area of 55,000 people. METHODS: A nine-item, previously validated screening instrument for detecting epilepsy in developing countries was forward-and-back translated into Chitonga. Early piloting indicated poor specificity among children, so three questions were added. Local census data were used to estimate the population at risk. Community health workers conducted screening interviews with household heads. All positive screens were referred for physician assessment. A blinded neurologist assessed a randomly selected subset (100 positives, 50 negatives) to determine screening instrument characteristics. RESULTS: We identified 799 people with possible epilepsy (unadjusted prevalence 14.5/1000). The adapted instrument exhibited 86% specificity (adjusted prevalence 12.5/1000). False positives occurred primarily among children who had experienced multiple malaria-associated seizures. Age-specific rates were highest for children aged 5-15 years (26.2/1000) and for people over 65 years (15.9/1000). Males were disproportionately represented (55.8%vs. 44.2%, P<0.05), although this trend reversed after childbearing age. CONCLUSION: Even using a relatively conservative definition, we identified almost 700 PWE. Use of the recommended epidemiological definitions would likely have yielded higher prevalence rates. The age-specific prevalence did not follow patterns described where neurocysticercosis is the commonest cause of epilepsy. Trends in age- and gender-specific prevalence may offer a clue to the aetiology of epilepsy in this region.     

Gender and hypertension management: a sub-analysis of the I-inSYST survey

Hypertension is a major risk factor for cardiovascular disease, which is the leading cause of death in women. Aim. To evaluate blood pressure control, prevalence of concomitant cardiovascular risk factors, subclinical and clinical organ damage, and treatment according to gender. Methods. 11,562 patients (49% women) from the cross-sectional I-inSyst survey in primary care were included. Results. Blood pressure control in women (21.8%) and men (21.2%) was similar, despite a slightly older age (64.9 vs 63 years, p<0.0001). Women had less concomitant cardiovascular risk factors and organ damage, with the exception of diabetes, cerebrovascular and renal disease, than men. They received more antihypertensive drugs than men (1.7 ± 0.9 vs 1.5 ± 0.9, p<0.0001). Diuretics were more (45% vs 36.5%, p<0.0001), calcium-channel blockers (26% vs 29%, p<0.003) and angiotensin-converting enzyme inhibitors (20% vs 22%, p<0.02) were less commonly prescribed in women than in men. Different clinical factors (i.e. age, duration of hypertension, smoking) in women and men were associated with blood pressure control, but gender itself was not. Conclusions. In this group of treated hypertensive patients, blood pressure control in women and men was not different. Women had a lower prevalence of most cardiovascular risk factors, subclinical and clinical organ damage. Antihypertensive drug treatment varied according to gender.     

The variance of hypertension prevalence detected by epidemiological survey against clinical practice: data from a rural population in South China

The present study intended to evaluate the variation of the hypertensive prevalence detected on a single-day blood pressure (BP) value against that on an average of 3-day BP values. This study included 1185 residents (age 21–94, 62.6 ± 14.0 years, 491 males) for BP measurements over three separate visits within a 7-day period. The newly diagnosed hypertension on the first day BP value was recorded as hypertension by epidemiological method, whereas that on the average of 3-day BP values as hypertension by clinical method. True positive rate (TPR) was the ratio of the newly diagnosed hypertensives by clinical method to those by epidemiological method. The overestimation ratio was calculated based on the following formula: (epidemiological prevalence–clinical prevalence)/epidemiological prevalence. Our results showed that of the 367 newly diagnosed hypertensives by epidemiological method, 308 were confirmed by clinical method, and with a TPR of 83.9%. The epidemiological prevalence of hypertension was higher than the clinical prevalence (41.1% vs. 36.1%) with an overestimation ratio of 12.2%. In addition, the participants aged <65 years had a lower TPR (77.9% vs. 87.8%, P = .012) against the participants aged ≥65 years. Furthermore, participants with systolic BP values of <160 mm Hg (78.2% vs. 100%, P < .001) or diastolic BP values of <100 mm Hg also had a lower TPR (70.1% vs. 100%, P = .006) compared with those having a systolic BP of 140–159 mm Hg or diastolic BP 90–99 mm Hg. It is concluded that in this population, the hypertension prevalence by epidemiological method is overestimated by 12.2% against clinical hypertension prevalence.     

Gender differences in the psychological determinants of cigarette smoking

Aims To compare the distributions of smoking‐related variables and the size of associations between these variables in men and women. Design and participants Mail survey in 2934 daily smokers (1533 women and 1401 men) who volunteered for a smoking cessation trial. Follow‐up after 7 months in 2456 people (84%). Setting Community setting (French‐speaking part of Switzerland, 1998). Findings Women smoked less than men (18 versus 22 cigarettes per day, p < 0.001), had lower confidence in their ability to refrain from smoking, used more frequently the strategy defined as ‘coping with the temptation to smoke’ and reported more drawbacks of smoking (gender differences ranged between 0.1 and 0.3 standard deviation units on these scales). There was no gender difference in the distribution of smokers by stage of change. At follow‐up, smoking cessation rates were similar in men and women (6% versus 5%, p = 0.3). Intention to quit, quit attempts in the previous year and a more frequent use of self‐change strategies predicted smoking cessation and were associated with tobacco dependence in both sexes. A more frequent use by women of coping strategies suggests that some women are ‘self‐restrained’ smokers who control their smoking permanently. This could explain lower smoking rates in women. The size of associations between smoking‐related variables was similar in men and women. Conclusions Even though there were gender differences in the distributions of some smoking‐related variables, associations between these variables were similar in men and women. This suggests that smoking behaviour is regulated by similar psychological mechanisms in men and women.     

Low prevalence of malnutrition in a rural Nigerian community

This study was carried out to determine the prevalence of malnutrition in a rural Nigerian community. Using the modified Wellcome Classification, the prevalence of protein energy malnutrition (PEM) was 20.5%. The prevalence of underweight, wasting and stunting were 23.1%t, 9% and 26.7%, respectively. The low prevalence of PEM in this rural Nigerian community may be due to the services and intervention provided by a non-governmental organization in the community. This method of intervention is similarly achievable in any other community.     

Gender and ethnicity differences in the prevalence of scleroderma-related autoantibodies

Autoantibodies to topoisomerase I (topo I), RNA polymerase III (RNAPIII), centromere, U3RNP/fibrillarin, Th, PM-Scl, and U1RNP found in scleroderma (SSc) are associated with unique clinical subsets. The effects of race and gender on autoantibody prevalence and clinical manifestations were examined. Autoantibodies in sera from 105 SSc (include 75 Caucasian, 24 African-American, 6 others; 89 females and 16 males) were analyzed by immunofluorescence and immunoprecipitation. Clinical information was from database. SSc-related autoantibodies seldom coexist except for anti-topo I and anti-U1RNP. Anti-topo I (35% vs 15%), anti-U3RNP (30% vs 3%, p = 0.0005), and anti-U1RNP (30% vs 13%) were more common in African-Americans vs Caucasians. Anti-centromere (17%) and anti-PM-Scl (only in 8% of female) were found only in Caucasians. In race/gender combination, all three African-American males had anti-topo I (p = 0.04). Anti-U3RNP (35% vs 3%, p = 0.0005) and anti-U1RNP were common in African-American females. In African-American, all nucleolar dominant staining sera had anti-U3RNP; nuclear pattern was topo I (50%), U1RNP (19%), and RNAPIII (13%). In Caucasian, nucleolar was anti-Th (43%) and PM-Scl (29%); nuclear pattern was RNAPIII (29%), topo I (24%), and U1RNP (18%). Anti-topo I, anti-RNAPIII, and anti-U3RNP were associated with diffuse SSc while anti-centromere, anti-Th, and anti-U1 with limited disease. Proximal scleroderma was less common in African-American with anti-topo I (38% vs 91% in Caucasian, p = 0.04). The production of SSc-related autoantibodies is gender and race dependent, and this can be highly relevant in understanding their clinical significance.     

Gender differences in the prevalence and determinants of the metabolic syndrome in screened subjects at risk for coronary heart disease

Background: The metabolic syndrome is prevalent among individuals with coronary heart disease (CHD) risk factors. This study's goal was to compare gender differences in the prevalence and determinants of the metabolic syndrome in subjects who were re-examined after a cardiovascular risk factor screening program. Methods: In a population-based cross-sectional study of 14,811 screened men and women aged 30, 40, 45, and 59 to 60 years, 1,491 subjects in the predetermined risk categories of high glucose (n = 64, 69% male), cholesterol (n = 496, 66.3% male), and blood pressure (n = 362, 63.5% male) or Framingham risk score (n = 253, 93.7% male) or low HDL cholesterol (n = 316, 79.1% male) underwent further examination. Results: The metabolic syndrome was more prevalent among women than among men in the same risk categories with the exception of the blood pressure category. Women with the metabolic syndrome had a higher BMI and C reactive protein (CRP) levels, and were more likely to meet the waist circumference criterion than men (92% versus 70%; P < 0.0001). In multivariate analysis, BMI (odds ration(OR) 25.8, 95% CI 14.3-46.3 for >/=30 kg/m(2) versus < 25 kg/m(2)), CRP (OR 1.9, 95% CI 1.3-2.7 for the highest versus the lowest tertile) and female gender (OR 1.7, 95% CI 1.2-2.3 versus male) were associated with the metabolic syndrome after adjustment for age, physical activity, smoking, and family history of premature cardiovascular disease. Conclusion: The metabolic syndrome was more prevalent and more strongly characterized by obesity and low grade inflammation in women than men. These findings underscore the need to study gender-specific approaches to screen for CHD risk.     

HIV voluntary counselling and testing in Nakuru, Kenya: findings from a community survey

OBJECTIVES: HIV voluntary counselling and testing (VCT) is important for prevention, detection and treatment of HIV infection. A study was conducted to determine the extent of utilization of VCT, and to study the attitudes and preferences of the community regarding VCT. METHODS: A total of 301 adults, aged 18-49 years, residing in Nakuru, Kenya were randomly selected using a two-stage sampling process. A self-administered questionnaire delivered during home visits was used to collect data over a 4-week period. RESULTS: The majority of study participants (184 of 287; 64.1%) had never been tested for HIV; 77 (26.8%) had received VCT, and 26 (9.1%) had received HIV testing without counselling. A total of 219 (78.2%) of the 280 responding participants expressed readiness to have VCT. The majority of participants (216 of 296; 73%) preferred VCT, while 46 (15.5%) preferred testing without counselling. The majority (227; 76.7%) preferred couple testing and dedicated clinics and private doctors' offices as testing facilities. The choice of a nearby facility was ranked above the provision of anonymity by most participants (162 of 298; 54.4%; vice versa for 136 of 298; 45.6%). CONCLUSIONS: With HIV/AIDS continuing to be a major public health concern in Kenya, the issues surrounding acceptance and use of VCT need to be addressed. Enhancing community awareness of the benefits of early HIV diagnosis, providing couple-based VCT as an integral part of VCT and increasing access to VCT testing sites may enhance utilization of VCT.     

Educational level and hypertension: how socioeconomic differences condition health care

This is the first European study that has evaluated educational level in a large sample of hypertensive outpatients. We established the educational level of the hypertensive outpatients in our unit, and determined whether the awareness of hypertension and its organ damage was education-related. We analysed data from 812 consecutive outpatients (378 men, mean age 50 +/- 10 years) with essential stage I-II hypertension. Subjects were subdivided into two categories: group A subjects were highly educated; group B subjects had a little education. Data were compared with educational level from the 1991 population census for the Campania region (ISTAT data) and with 200 type 2 diabetes patients (96 men, mean age 51 +/- 9 years) from the nearest diabetes unit. For each hypertensive patient we considered clinical, echocardiographic and biochemical parameters. Data from the last census showed a high percentage (80%) of subjects with low education. The percentage of type 2 diabetic patients with little education was high (190 patients, 95%). Conversely, it is somewhat surprising that most hypertensive patients reached high standards of education and worked at sedentary jobs (group A: 736 patients, 91%; P < 0.0001). Multivariate analysis showed that only diastolic blood pressure (P = 0.03) was independently associated with low educational level. Compared to diabetes, hypertension and its risk factors are relatively unknown to people with little education. Education is associated with greater health care and awareness that may overcome the risk related to low physical activity. Thus, we stress the importance of a sound health policy able to reach out to the uneducated and make them aware of hypertension and the health care services available to them.