RESUMEN
OBJECTIVES: To evaluate waist circumference (WC) as a screening tool for obesity in a Caribbean population. To identify risk groups with a high prevalence of (central) obesity in a Caribbean population, and to evaluate associations between (central) obesity and self-reported hypertension and diabetes mellitus. DESIGN: Cross-sectional. SETTING: Population-based study. SUBJECTS: A random sample of adults (18 y or older) was selected from the Population Registries of three islands of the Netherlands Antilles. Response was over 80%. Complete data were available for 2025 subjects. INTERVENTION: A questionnaire and measurements of weight, height, waist and hip. MAIN OUTCOME MEASUREMENT: Central obesity indicator (WC > or =102 cm men, > or =88 cm women). RESULTS: WC was positively associated with age (65-74 y vs 18-24 y) in men (OR=7.7, 95% CI 3.4-17.4) and women (OR=6.4, 95% CI 3.2-12.7). Women with a low education had a higher prevalence of central obesity than women with a high education (OR=0.5, 95% CI 0.3-0.7). However, men with a high income had a higher prevalence of a central obesity than men with a low income (OR=1.7, 95% CI=1.1-2.6). WC was the strongest independent obesity indicator associated with self-reported hypertension (OR=1.7, 95% CI 1.4-2.0) and diabetes mellitus (OR=1.6, 95% CI 1.3-1.9). CONCLUSIONS: The identified risk groups were women aged 55-74 y, women with a low educational level and men with a high income. WC appears to be the major obesity indicator associated with hypertension and diabetes mellitus. SPONSORSHIP: Island Governments of Saba, St Eustatius and Bonaire, the Federal Government of the Netherlands Antilles, Dutch Directorate for Kingdom relationships.
Asunto(s)
Constitución Corporal/fisiología , Diabetes Mellitus Tipo 2/epidemiología , Hipertensión/epidemiología , Obesidad/epidemiología , Obesidad/fisiopatología , Adulto , Factores de Edad , Anciano , Intervalos de Confianza , Estudios Transversales , Diabetes Mellitus/epidemiología , Diabetes Mellitus Tipo 2/etiología , Escolaridad , Femenino , Encuestas Epidemiológicas , Humanos , Hipertensión/etiología , Renta , Masculino , Persona de Mediana Edad , Antillas Holandesas/epidemiología , Obesidad/diagnóstico , Oportunidad Relativa , Factores de Riesgo , Factores Sexuales , Encuestas y CuestionariosRESUMEN
'The Saba Health Study' is the first large scale health interview survey of the island. This book presents the main results of the study. It discusses the population's health status, use of health services, and satisfaction with health care. Known health risks, such as smoking, alcohol consumption, and overweight are evaluated and compared with situations on the sister island of Curacao and in western countries. Attention is focused on the identification of risk groups in need of specific policy interventions and health promotion programs (AU)
Asunto(s)
Adulto , Humanos , Estudio Comparativo , Encuestas de Atención de la Salud , Estado de Salud , Investigación sobre Servicios de Salud , Calidad, Acceso y Evaluación de la Atención de Salud , Antillas Holandesas , Estilo de Vida , Región del Caribe , Promoción de la Salud , ÉticaRESUMEN
In this study, we test the assumption that sociocultural differences in use of health services will occur only below a certain level of illness severity. Data are derived from the Curacao Health Study (N = 2248). Subjects' educational level and degree of proto-professionalisation were used as indicators of their sociocultural background. Differences in the likelihood of seeking professional care for several common health problems were analysed, and were compared with the help seeking behaviour for chronic disorders. As hypothesised, more highly educated and proto-professionalised people were less likely to seek care for everyday symptoms. In addition, proto-professionalisation was accompanied by a greater likelihood of using over the counter medication. Increasing empowerment of patients appeared to lead to increase self care for everyday symptoms. When conditions reached a more serious stage, the difference in help-seeking behaviour disappeared. For most of the chronic conditions studied, the higher educated and more proto-professional treatment as the less advantaged groups. However, there was a difference as to the type of professional consulted for chronic health problems. Proto-professionalised individuals more often received specialist treatment, probably because they were better equipped to persuade GPs to refer. The adverse side of patient empowerment may be increasing consumerism.(AU)
Asunto(s)
Humanos , Actitud Frente a la Salud , Aceptación de la Atención de Salud , Factores Socioeconómicos , Enfermedad CrónicaRESUMEN
In this study, we test the assumption that sociocultural differences in use of health services will only occur below a certain level of illness severity. Data are derived from the Curaçao Health Study (n = 2248). Subjects' educational level and degree of proto-professionalization are used as indicators of their sociocultural background. Differences in the likelihood of seeking professional care for several common health problems are analyzed, and are compared with the help-seeking behavior for chronic disorders. As hypothesized, higher educated and proto-professionalized people are less likely to seek care for everyday symptoms. In addition, proto-professionalization is accompanied by a greater likelihood of using over the counter medication. Increasing empowerment of patients appears to lead to increased self care for everyday symptoms. When conditions reach a more serious stage, the differences in help-seeking behavior disappear: for most of the chronic conditions studied, the higher educated and more proto-professionalized individuals are just as likely to seek professional treatment as the less advantaged groups. However, there is a difference as to the type of professional consulted for chronic health problems. Proto-professionalized individuals more often receive specialist treatment, probably because they are better equipped to persuade GPs to refer. The adverse side of patient empowerment may be increasing consumerism: a situation in which patient demands, not medical necessity, determine the care delivered.
Asunto(s)
Actitud Frente a la Salud , Aceptación de la Atención de Salud/etnología , Enfermedad Aguda , Enfermedad Crónica , Características Culturales , Humanos , Entrevistas como Asunto , Funciones de Verosimilitud , Antillas Holandesas , Aceptación de la Atención de Salud/estadística & datos numéricos , Poder Psicológico , Autocuidado , Clase Social , Factores SocioeconómicosRESUMEN
OBJECTIVE: The aim of the article is to report the prevalence of obesity, abdominal fatness and waist circumference in different socioeconomic classes in Curaçao. DESIGN: In 1993/1994 a health interview survey (the Curaçao Health Study) was carried out among a random sample (n = 2248, response rate = 85%) of the adult non-institutionalized population of Curaçao. METHODS: We analyzed the association between obesity (BMI > or = 30), abdominal fatness (waist hip ratio (WHR) > or = 0.95 for men, WHR > or = 0.80 for women) waist circumference (WC > or = 100 cm for men, WC > or = 91 cm for women) and socioeconomic status (SES) by age adjusted logistic regressions, for men and women separately. RESULTS: The prevalence of obesity was about 27%: 36% of the women and 19% of the men were obese. An at risk WHR was reported among 62.2% of the women and among 20.4% of the men. A WC above the cut-off point was reported for 44.3% women and 25.3% men. Compared to women of higher SES, the lower SES women have a two to three times higher risk of a BMI, WHR or WC exceeding the cut-off points. Among men, no statistically significant difference between an increased BMI, WHR or WC and SES factors was found. The overlap between the three measures is large, about 56% of the women scored similarly on all three measurements. Among men the overlap is even greater (73%). CONCLUSIONS: The prevalence of obesity in Curaçao is alarming. Low SES women are at the greatest risk of an increased BMI, WHR or WC. The obesity figures can be placed between industrialized societies and less modernized cultures. Action and additional research on the prevention of obesity in Curaçao are deemed necessary. The cut-off points in our study for WC in the non-white population are preliminary and need to be elucidated further.
Asunto(s)
Obesidad/epidemiología , Clase Social , Adulto , Factores de Edad , Anciano , Constitución Corporal , Índice de Masa Corporal , Escolaridad , Femenino , Humanos , Renta , Modelos Logísticos , Masculino , Persona de Mediana Edad , Antillas Holandesas/epidemiología , Ocupaciones , Prevalencia , Factores Sexuales , Encuestas y CuestionariosRESUMEN
The aim of this study is to examine whether there is socioeconomic equity in health care utilization in Curaçao, Netherlands Antilles. We explore how educational level is related to utilization of GPs, specialists, hospitals; dentists and physiotherapists, taking into account the effects of sex, age and inequalities in health. The study also examines whether these relationships vary according to the unit of analysis: probability (or incidence) of services use versus overall volume of contacts. The data were derived from the Curaçao Health Study, a health interview survey among a random sample (N = 2248) of the non-institutionalized population aged 18 and over. The results indicate that there is socioeconomic inequity in the probability of health care utilization in Curaçao. People with a higher educational level are more likely to consult a specialist, dentist or physiotherapist, and are also more likely to be hospitalized. This is not only the case when the mediating effects of socioeconomic inequalities in health (need) are taken into account, but also before adjustment for health inequalities. In other words: there appears to be both vertical inequity (i.e. greater needs for services are not met by greater use) and horizontal inequity (i.e. similar needs for care are not met by similar levels of services use). The observed inequalities in use of specialists and hospitals contrast with findings from international research. The volume of health services use (i.e. the numbers of consultations) appears to be hardly connected with a person's position in the SES hierarchy; only dental services are used more extensively by higher educated individuals.
Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Indigencia Médica/estadística & datos numéricos , Grupo de Atención al Paciente/estadística & datos numéricos , Factores Socioeconómicos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Escolaridad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Antillas Holandesas , Revisión de Utilización de RecursosRESUMEN
Curacao, as well as other Caribbean islands, has a growing number of the elderly. In this study we analyzed the home care needed and received by the elderly. Such data are needed for planning health services. Data from the Curacao Health Study were used for this purpose: a face-to-face interview among a random sample of the population. Of the elderly (aged 65 years and over) 23 percent needed help with one or more activities of daily living (ADL), 6 percent needed help with three or more ADL. Those aged over 75 years especially needed help with these activities. 22 percent of the elderly received informal care, consisting mainly of household tasks, accompaniment or monitoring and emotional support. Daughters were the most important care givers, followed by sons. Elderly with multiple ADL - impairments more often received informal care and also more intensive care (more physical care, e.g. bathing). 24 percent of the study sample indicated that they had no one to take care of them in case of long-term illness. This occurred more often when elderly people live alone (50 percent). The ageing of the population will result in a higher need for informal care. However, social changes such as fewer children per couple, a growing number of elderly living alone and increased participation of women in the labour force, will result in fewer potential caregivers. Ways to stimulate informal care and organize cost-effective formal care should therefore be sought.(AU)
Asunto(s)
Humanos , Atención Domiciliaria de Salud , Anciano , Actividades CotidianasRESUMEN
This study examines whether there is socioeconomic equity in health care utilization in Curacao. We explore how education level is related to utilization of various health services, taking into account the effects of sex, age, and inequalities in health. The study also examines whether these relationships vary according to the unit of analysis; probability (or incidence) of services use versus overall volume contacts. The data was derived from the "Curacao health study", a health interview survey among a random sample (n=2248) of the non-institutionalized population 18 years and over. The results indiacte that there is socio-economic inequalities in health (need for care) is taken into account. In other words: greater need for services are not met by greater use (vertical equity) and similar needs for care are not met by similar levels of service use (horizontal inequity). The volume of use (i.e. the number of consultations with a care provider, once a person has entered the health care system) appears to be fairly equitable. The observed inequalities in probability of specialist and health utilization contrast with findings from international research. The outcomes of this study underline the importance of health care reforms in order to attain more equitatble access to health care. (AU)
Asunto(s)
Humanos , Servicios de Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud , Factores SocioeconómicosRESUMEN
The aim of this paper is to report the prevalence of obesity and abdominal fatness in different socioeconomic classes in Curacao. In 1993/1994 a health interview survey (the Curacao Health Study) was carried out among a random sample (n = 2248, response rate = 85 percent) of the adult non-institutionalized population of Curacao. We analyzed the association between body mass index (BMI) and socioeconomic status (SES) as well as the relationship between waist-hip ratio (WHR) and SES by logistic regression models for men and women separately. The overall prevalence of obesity among women peaked at age 46 to 55 years (OR 4.195 percent CI 2.6 - 6.6) and between 56 to 65 (OR 1.7 95 percent CI 1.0 - 3.1) years in men. Women of lower SES are approximately twice as much at risk of being obesed compared to women of higher SES (OR 2.4 95 percent CI 1.7 - 3.4) for the low SES group. The percentage of participants with an at risk WHR (cut off point 0.80 for women and 0.95 for men) is more than three times higher among women than among men (62.2 percent versus 20.4 percent). WHR increased significantly with age among both genders. Compared to women of higher SES, the lower SES women have a three times higher risk of a WHR exceeding th cut off point (OR 3.0 95 percent CI 2.0 - 4.5). The overall prevalence of obesity was much higher than in Spain, Brazil and the Netherlands. The high prevalence of obesity in Curacao justifies action and research on the prevention of obesity in Curacao. (AU)
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Obesidad/epidemiología , Clase Social , Índice de Masa Corporal , Aumento de Peso , Factores SocioeconómicosRESUMEN
The Curaçao Health Study was carried out among a randomized sample (n = 2248, response rate = 85%) of the adult non-institutionalized population in order to assess aspects of lifestyle that may pose health risks. Factors examined were tobacco and alcohol use, eating habits and exercise behaviour. Outcome variables were cross-tabulated by gender, age and socioeconomic status. 17.1% of the participants were smokers and 20.5% were regular drinkers, including 6.3% of the men who consumed alcohol excessively (4 or more glasses of alcohol a day). 75% of the participants did not exercise regularly, 37% did not eat vegetables daily, and half did not eat fruit daily. Other poor eating habits were the addition of extra sugar and salt to prepared food by 33% and 20% of the participants, respectively. On the whole, men had less healthy lifestyles than women, with the exception of exercise behaviour. People of high socioeconomic status (SES) drank less alcohol, and exercised more often than those of low SES. Considering the high prevalence of diabetes mellitus and hypertension in the Caribbean, research on lifestyle factors in other Caribbean countries is required to facilitate the development of regional prevention and intervention programmes.
Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Ejercicio Físico , Conducta Alimentaria , Estilo de Vida , Fumar/epidemiología , Adolescente , Adulto , Anciano , Dieta , Femenino , Humanos , Masculino , Persona de Mediana Edad , Antillas Holandesas/epidemiologíaRESUMEN
The Curacao Health Study was carried out among a randomized sample (n = 2248, response rate = 85 percent) of the adult non-institutionalized population in order to assess aspects of lifestyle that may pose health risks. Factors examined were tobacco and alcohol use, eating habits and exercise behaviour. Outcome variables were cross-tabulated by gender, age and socioeconomic status. 17.1 percent of the participants were smokers and 20.5 percent regular drinkers, including 6.3 percent of the men who consumed alcohol excessively (4 or more glasses of alcohol a day). 75 percent of the participants did not excercise regularly, 37 percent did not eat vegetables daily, and half did not eat fruit daily. Other poor eating habits were the addition of extra sugar and salt to prepared food by 33 percent and 20 percent of the participants, respectively. On the whole, men had less healthy lifestyles than women, with the exception of execise behaviour. People of high socioeconomic status (SES) drank less alcohol, and exercised more often than those of low SES. Considering the high prevalence of diabetes mellitus and hypertension in the Caribbean, research of lifestyle factors in other Caribbean countries is required to facilitate the development of regional prevention and intervention programmes. (AU)
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tabaquismo/epidemiología , Consumo de Bebidas Alcohólicas/epidemiología , Ejercicio Físico , Estilo de Vida , Conducta Alimentaria , Factores Socioeconómicos , Factores Sexuales , Factores de Riesgo , Escolaridad , Indicadores de MorbimortalidadRESUMEN
The Curacao Health Study was carried out among a randomized sample (n = 2248, response rate = 85 percent) of the adult non-institutionalized population in order to assess aspects of lifestyle that may pose health risks. Factors examined were tobacco and alcohol use, eating habits and exercise behaviour. Outcome variables were cross-tabulated by gender, age and socioeconomic status. 17.1 percent of the participants were smokers and 20.5 percent regular drinkers, including 6.3 percent of the men who consumed alcohol excessively (4 or more glasses of alcohol a day). 75 percent of the participants did not excercise regularly, 37 percent did not eat vegetables daily, and half did not eat fruit daily. Other poor eating habits were the addition of extra sugar and salt to prepared food by 33 percent and 20 percent of the participants, respectively. On the whole, men had less healthy lifestyles than women, with the exception of execise behaviour. People of high socioeconomic status (SES) drank less alcohol, and exercised more often than those of low SES. Considering the high prevalence of diabetes mellitus and hypertension in the Caribbean, research of lifestyle factors in other Caribbean countries is required to facilitate the development of regional prevention and intervention programmes.
Asunto(s)
Adulto , Femenino , Humanos , Persona de Mediana Edad , Consumo de Bebidas Alcohólicas/epidemiología , Ejercicio Físico , Fumar/epidemiología , Estilo de Vida , Factores Socioeconómicos , Factores Sexuales , Indicadores de Morbimortalidad , Factores de Riesgo , EscolaridadRESUMEN
This paper describes the epidemiology of health care utilization in Curacao. The data presented are derived from the Curacao Heatlh Study, a health interview survey among a representative sample of the adult non-institutionalized population (n=2 248) which was carried out in 1993-1994. The outcome is compared to data on health care utilization in The Netherlands in 1994. In general, the use of GPs, specialists and hospitals in Curacao is fairly similar to that of The Netherlands, but the use of dentists and physiotherapists is markedly lower in Curacao. Some distinct differences in utilization of health services between the various population groups are revealed by the data presented in this paper. Women have a higher average level of health services utilization than men, which is in accordance with the fact that in general women's health status is somewhat less good than that of men. Older people make more use of specialists and district nursing care, and are more often hospitalized than young and middle-aged people. This is not surprising, in view of the fact, that in general aging is accompanied by a deterioration in health and a greater need for medical care. In this light, it is striking that older people do not make more use of the services of GPs than younger individuals (AU)
Asunto(s)
Adulto , Humanos , Persona de Mediana Edad , Servicios de Salud/estadística & datos numéricosRESUMEN
The objectives of this paper are to describe the findings on knowledge and attitudes concerning substance use (tobacco and alcohol) among the participants of the Curacao Health Study and to relate these results to their behaviour. A random sample of the adult non-institutionalized population of Curacao (n=2248) were asked about their knowledge and attitudes on health lifestyle patterns and preventive behaviour. In this paper we specifically focus on smoking and use of alcohol. Men in Curacao use more alcohol and tobacco than women. The prevalence of self-reported smokers is markedly lower than, for instance, in the Dutch population and that of the U.S. and the difference between the sexes. In Curacao men generally also score lower on knowledge and attitudes regarding the use of tobacco and alcohol than women. Those actually exhibiting unhealthier lifestyles in this respect have lower scores than those having healthier lifestyles. The same relationship holds true for women, though less pronounced. Although knowledge, attitudes and behaviour are clearly associated with one another, the causal relationship between them is not unequivocal. Other factors may also play a role in influencing lifestyle changes. More research is needed to guide the further development and implementation of health promotion and intervention programmes in Curacao (AU)x
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Conocimientos, Actitudes y Práctica en Salud , Trastornos Relacionados con Sustancias/psicología , Alcoholismo/psicología , Estilo de Vida , Factores SexualesRESUMEN
The objective of this study was to describe the relationship between perceived social support and mental health in Curacao. A random sample (n=2248) of the non-institutionalized adult population of Curacao was surveyed through face-to-face interviews, containing items on health, social support and background variables. The prevalence of psychological distress was about 20 percent. The prevalence was higher in women, widowed persons, the chronically ill and persons from the low socio-economic classes. Perceived social support was relatively low in young persons, divorced and single persons, the chronically ill and low education groups. There was a strong inverse relationship between perceived social support and psychological distress: persons who feel they have low social support have more psychological distress. This relationship could be found in almost all subgroups, but is especially strong in young women. Prevention and intervention programmes should acknowledge the great impact of social support on mental health. In terms of prevention of psychological distress, people in stressful situations should be helped by reinforcing their social support (e.g. patient should be helped to improve their social support (e.g. halfway houses for (former) psychiatric patients) (AU)
Asunto(s)
Femenino , Humanos , Masculino , Calidad de Vida , Apoyo Social , Salud Mental , Factores SocioeconómicosRESUMEN
In Curacao, individuals from the lower socio-economic strata are relatively disadvantaged with regard to both their physical and their mental health. They also have a relatively poorer perceived health. The objective of the current study was to investigate whether gender and age-specific socio-economic health differences can be found in Curacao. In order to do this, analyses were performed on data from 2248 of a random sample of 3000 persons from the Curacao Health Study. Averaged over all age groups, a socio-economic gradient was found in males with respect to physical functioning and in females with respect to the number of chronic conditions. Regarding mental health and perceived general health, socio-economic differences were found in both males and females. To determine whether these socio-economice differences in physical health were more prominent. In mental health the differences appeared in younger age groups, for males as well as females. In the latter the differences are more prolonged. The proportion of persons in "average" or "poor' health differed by socio-economic status in early old age in males and in early middle age in females. In short-term complaints, no socio-economic differences were found, except for females in the middle age group (45 - 54 years). Socio-economic health differences exist in Curacao. These differences are not apparent for all health indicators, they vary by gender and age group. In efforts to reduce socio-economic inequalities in adult health these factors have to be taken into account and, depending on the health indicator of interest, policy must be formulated geared towards specific groups (AU)