RESUMO
OBJECTIVE: To estimate the 2009 prevalence of diagnosed diabetes in Puerto Rico among adults ≥ 20 years of age in order to gain a better understanding of its geographic distribution so that policymakers can more efficiently target prevention and control programs. METHODS: A Bayesian multilevel model was fitted to the combined 2008-2010 Behavioral Risk Factor Surveillance System and 2009 United States Census data to estimate diabetes prevalence for each of the 78 municipios (counties) in Puerto Rico. RESULTS: The mean unadjusted estimate for all counties was 14.3% (range by county, 9.9%-18.0%). The average width of the confidence intervals was 6.2%. Adjusted and unadjusted estimates differed little. CONCLUSIONS: These 78 county estimates are higher on average and showed less variability (i.e., had a smaller range) than the previously published estimates of the 2008 diabetes prevalence for all United States counties (mean, 9.9%; range, 3.0%-18.2%).
Assuntos
Diabetes Mellitus/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Porto Rico/epidemiologia , Análise de Pequenas Áreas , Adulto JovemRESUMO
OBJECTIVE: To estimate the 2009 prevalence of diagnosed diabetes in Puerto Rico among adults > 20 years of age in order to gain a better understanding of its geographic distribution so that policymakers can more efficiently target prevention and control programs. METHODS: A Bayesian multilevel model was fitted to the combined 2008-2010 Behavioral Risk Factor Surveillance System and 2009 United States Census data to estimate diabetes prevalence for each of the 78 municipios (counties) in Puerto Rico. RESULTS: The mean unadjusted estimate for all counties was 14.3% (range by county, 9.9%-18.0%). The average width of the confidence intervals was 6.2%. Adjusted and unadjusted estimates differed little. CONCLUSIONS: These 78 county estimates are higher on average and showed less variability (i.e., had a smaller range) than the previously published estimates of the 2008 diabetes prevalence for all United States counties (mean, 9.9%; range, 3.0%-18.2%).
OBJETIVO: Calcular la prevalencia en el año 2009 de casos con diagnóstico de diabetes en Puerto Rico en adultos de 20 años de edad o mayores, para conocer mejor su distribución geográfica con objeto de que los responsables políticos puedan encauzar más eficientemente los programas de prevención y control. MÉTODOS: Se ajustó un modelo multinivel bayesiano a la combinación de datos del Sistema de Vigilancia de Factores de Riesgo del Comportamiento 2008-2010 y del Censo de los Estados Unidos del 2009 para calcular la prevalencia de la diabetes en cada uno de los 78 municipios de Puerto Rico. RESULTADOS: El cálculo del valor medio no ajustado para todos los municipios fue de 14,3% (intervalo por municipio de 9,9 a 18,0%). La amplitud promedio de los intervalos de confianza fue de 6,2%. Hubo poca diferencia entre los cálculos ajustados y los no ajustados. CONCLUSIONES: Los valores obtenidos mediante estos cálculos correspondientes a 78 municipios fueron por término medio más elevados y mostraron menor variabilidad (es decir, el intervalo era más pequeño) que los cálculos anteriormente publicados sobre la prevalencia de la diabetes en todos los municipios de los Estados Unidos en el 2008 (media, 9,9%; intervalo de 3,0 a 18,2%).
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Diabetes Mellitus/epidemiologia , Prevalência , Porto Rico/epidemiologia , Análise de Pequenas ÁreasAssuntos
Diabetes Mellitus , Prevalência , Política Pública , Porto Rico , Política Pública , Porto Rico , Análise de Pequenas Áreas , PrevalênciaRESUMO
Diabetes is a serious public health problem in the border region between the United States of America and Mexico, reflecting and by some measures surpassing the extent of national diabetes burden of each country. The U.S.-Mexico Border Diabetes Prevention and Control Project, a two-phase prevalence study on type 2 diabetes and its risk factors, was conceived and developed by culturally diverse groups of people representing more than 100 government agencies and nongovernmental organizations; health care providers; and residents of 10 U.S. and Mexican border states, using a participatory approach, to address this disproportionate incidence of diabetes. This report describes the project's history, conceptualization, participatory approach, implementation, accomplishments, and challenges, and recommends a series of steps for carrying out other binational participatory projects based on lessons learned.
Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Programas Governamentais/história , Inquéritos Epidemiológicos/história , Adulto , Centers for Disease Control and Prevention, U.S. , Estudos Transversais/economia , Estudos Transversais/história , Estudos Transversais/métodos , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/etnologia , Feminino , Órgãos Governamentais , Programas Governamentais/economia , Programas Governamentais/métodos , Programas Governamentais/organização & administração , Inquéritos Epidemiológicos/economia , Inquéritos Epidemiológicos/métodos , História do Século XX , História do Século XXI , Humanos , Relações Interinstitucionais , Cooperação Internacional , Masculino , México/epidemiologia , Organização Pan-Americana da Saúde , Avaliação de Programas e Projetos de Saúde , Sudoeste dos Estados Unidos/epidemiologia , Estados Unidos , Organização Mundial da SaúdeRESUMO
OBJECTIVE: To examine the relationship between access to health care and undiagnosed diabetes among the high-risk, vulnerable population in the border region between the United States of America and Mexico. METHODS: Using survey and fasting plasma glucose data from Phase I of the U.S.-Mexico Border Diabetes Prevention and Control Project (February 2001 to October 2002), this epidemiological study identified 178 adults 18-64 years old with undiagnosed diabetes, 326 with diagnosed diabetes, and 2 966 without diabetes. Access to health care among that sample (n = 3,470), was assessed by type of health insurance coverage (including "none"), number of health care visits over the past year, routine pattern of health care utilization, and country of residence. RESULTS: People with diabetes who had no insurance and no place to go for routine health care were more likely to be undiagnosed than those with insurance and a place for routine health care (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.0-6.6, and OR 4.5, 95% CI 1.4-14.1, respectively). When stratified by country, the survey data showed that on the U.S. side of the border there were more people with undiagnosed diabetes if they were 1) uninsured versus the insured (28.9%, 95% CI 11.5%-46.3%, versus 9.1%, 95% CI 1.5%-16.7%, respectively) and if they 2) had made no visits or 1-3 visits to a health care facility in the past year versus had made ≥ 4 visits (40.8%, 95% CI 19.6%-62.0%, and 23.4%, 95% CI 9.9%-36.9%, respectively, versus 2.4%, 95% CI -0.9%-5.7%) (all, P < 0.05). No similar pattern was found in Mexico. CONCLUSIONS: Limited access to health care--especially not having health insurance and/or not having a place to receive routine health services--was significantly associated with undiagnosed diabetes in the U.S.-Mexico border region.
Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Adulto , Glicemia/análise , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Instalações de Saúde/estatística & dados numéricos , Instalações de Saúde/provisão & distribuição , Inquéritos Epidemiológicos , Humanos , Cobertura do Seguro , Masculino , Pessoas sem Cobertura de Seguro de Saúde , México/epidemiologia , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fatores de Risco , Fatores Socioeconômicos , Sudoeste dos Estados Unidos/epidemiologia , Inquéritos e Questionários , Populações Vulneráveis , Adulto JovemRESUMO
Diabetes is a serious public health problem in the border region between the United States of America and Mexico, reflecting and by some measures surpassing the extent of national diabetes burden of each country. The U.S.-Mexico Border Diabetes Prevention and Control Project, a two-phase prevalence study on type 2 diabetes and its risk factors, was conceived and developed by culturally diverse groups of people representing more than 100 government agencies and nongovernmental organizations; health care providers; and residents of 10 U.S. and Mexican border states, using a participatory approach, to address this disproportionate incidence of diabetes. This report describes the project's history, conceptualization, participatory approach, implementation, accomplishments, and challenges, and recommends a series of steps for carrying out other binational participatory projects based on lessons learned.
La diabetes es un problema grave de salud pública en la zona fronteriza entre México y los Estados Unidos, que refleja y, en cierta medida, sobrepasa la magnitud de la carga nacional de la diabetes de cada país. El Proyecto de Prevención y Control de la Diabetes en la Frontera México-Estados Unidos, un estudio de prevalencia de dos fases sobre la diabetes tipo 2 y sus factores de riesgo, se ideó y elaboró por grupos de personas culturalmente diversos que representaban a más de 100 organismos estatales y organizaciones no gubernamentales, profesionales de salud y residentes de 10 estados de la zona fronteriza entre México y los Estados Unidos, con la aplicación de un enfoque participativo, a fin de estudiar esta desproporcionada incidencia de diabetes. En este informe se describen la historia, la conceptualización, el enfoque participativo, la ejecución, los logros y los retos del proyecto, y se recomienda una serie de pasos para la realización de otros proyectos participativos binacionales, a partir de las lecciones aprendidas.
Assuntos
Humanos , Masculino , Feminino , Adulto , História do Século XX , História do Século XXI , /prevenção & controle , Programas Governamentais/história , Inquéritos Epidemiológicos/história , Centers for Disease Control and Prevention, U.S. , Estudos Transversais/economia , Estudos Transversais/história , Estudos Transversais/métodos , /epidemiologia , /etnologia , Órgãos Governamentais , Programas Governamentais/economia , Programas Governamentais/métodos , Programas Governamentais/organização & administração , Inquéritos Epidemiológicos/economia , Inquéritos Epidemiológicos/métodos , Relações Interinstitucionais , Cooperação Internacional , México/epidemiologia , Organização Pan-Americana da Saúde , Avaliação de Programas e Projetos de Saúde , Sudoeste dos Estados Unidos/epidemiologia , Estados Unidos , Organização Mundial da SaúdeRESUMO
OBJETIVE: To examine the relationship between access to health care and undiagnosed diabetes among the high-risk, vulnerable population in the border region between the United States of America and Mexico. METHODS: Using survey and fasting plasma glucose data from Phase I of the U.S.-Mexico Border Diabetes Prevention and Control Project (February 2001 to October 2002), this epidemiological study identified 178 adults 18-64 years old with undiagnosed diabetes, 326 with diagnosed diabetes, and 2 966 without diabetes. Access to health care among that sample (n = 3 470), was assessed by type of health insurance coverage (including "none"), number of health care visits over the past year, routine pattern of health care utilization, and country of residence. RESULTS: People with diabetes who had no insurance and no place to go for routine health care were more likely to be undiagnosed than those with insurance and a place for routine health care (odds ratio [OR] 2.6, 95 percent confidence interval [CI] 1.0-6.6, and OR 4.5, 95 percent CI 1.4-14.1, respectively). When stratified by country, the survey data showed that on the U.S. side of the border there were more people with undiagnosed diabetes if they were 1) uninsured versus the insured (28.9 percent, 95 percent CI 11.5 percent-46.3 percent, versus 9.1 percent, 95 percent CI 1.5 percent-16.7 percent, respectively) and if they 2) had made no visits or 1-3 visits to a health care facility in the past year versus had made > 4 visits (40.8 percent, 95 percent CI 19.6 percent-62.0 percent, and 23.4 percent, 95 percent CI 9.9 percent-36.9 percent, respectively, versus 2.4 percent, 95 percent CI -0.9 percent-5.7 percent) (all, P < 0.05). No similar pattern was found in Mexico. CONCLUSIONS: Limited access to health care-especially not having health insurance and/or not having a place to receive routine health services-was significantly associated with undiagnosed diabetes in the U.S.-Mexico border region.
OBJETIVO: Examinar la relación entre el acceso a la atención de salud y la diabetes no diagnosticada en la población de alto riesgo y vulnerable de la zona fronteriza entre México y los Estados Unidos. MÉTODOS: Mediante el uso de los datos de la encuesta y de la glucosa plasmática en ayunas de la fase I del Proyecto de Prevención y Control de la Diabetes en la Frontera México-Estados Unidos (de febrero del 2001 a octubre del 2002), en este estudio epidemiológico se identificaron 178 adultos de 18 a 64 años con diabetes no diagnosticada, 326 con diabetes diagnosticada y 2 966 sin diabetes. Se evaluó el acceso a la atención de salud en dicha muestra (n = 3 470), mediante el tipo de cobertura del seguro de salud (incluida "ninguna"), el número de consultas de atención de salud en el último año, las características de utilización de los servicios de salud y el país de residencia. RESULTADOS: La probabilidad de no tener un diagnóstico fue mayor en las personas que padecían diabetes y que no tenían seguro ni ningún lugar al que acudir para recibir la atención de salud que en las que sí contaban con seguro y un lugar para recibir atención de salud (razón de momios [OR], 2,6, intervalo de confianza [IC] del 95 por ciento 1,0-6,6, y OR de 4,5, IC 95 por ciento 1,4-14,1, respectivamente). Al estratificar los datos por país, los datos de la encuesta mostraron que, en el lado estadounidense de la frontera, había un mayor número de personas con diabetes no diagnosticada si: 1) no tenían seguro, frente a los asegurados (28,9 por ciento, IC 95 por ciento 11,5 por ciento-46,3 por ciento, en comparación con el 9,1 por ciento, IC 95 por ciento 1,5 por ciento-16,7 por ciento, respectivamente), y si: 2) no habían tenido consultas o habían tenido de una a tres consultas en un centro de atención de salud en el último año, en comparación con > 4 consultas (40,8 por ciento, IC 95 por ciento 19,6 por ciento- 62,0 por ciento, y 23,4 por ciento, IC 95 por ciento 9,9 por ciento-36,9 por ciento, respectivamente, en comparación con el 2,4 por ciento, IC 95 por ciento -0,9 por ciento-5,7 por ciento) (todos, p < 0.05). No se observó una pauta parecida en México. CONCLUSIÓN: En la región fronteriza entre México y los Estados Unidos, el acceso limitado a la atención de salud, especialmente si no se cuenta con un seguro de salud o no se tiene un lugar al que acudir para recibir atención de salud, mostró una relación significativa con la diabetes no diagnosticada.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , /epidemiologia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Glicemia/análise , /sangue , /diagnóstico , Instalações de Saúde/provisão & distribuição , Instalações de Saúde , Inquéritos Epidemiológicos , Cobertura do Seguro , Pessoas sem Cobertura de Seguro de Saúde , México/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Inquéritos e Questionários , Fatores de Risco , Fatores Socioeconômicos , Sudoeste dos Estados Unidos/epidemiologia , Populações Vulneráveis , Adulto JovemAssuntos
Diabetes Mellitus Tipo 2 , Fatores de Risco , Saúde na Fronteira , Cooperação Internacional , México , Estados Unidos , Diabetes Mellitus Tipo 2 , Fatores de Risco , Saúde na Fronteira , Cooperação Técnica , Estados Unidos , Inquéritos Epidemiológicos , Sudoeste dos Estados Unidos , Programas Governamentais , Estudos Transversais , Órgãos Governamentais , Relações Interinstitucionais , Cooperação Internacional , Organização Pan-Americana da Saúde , Avaliação de Programas e Projetos de Saúde , Organização Mundial da Saúde , Centers for Disease Control and Prevention, U.S.Assuntos
Diabetes Mellitus Tipo 2 , Diagnóstico , Saúde na Fronteira , Estados Unidos , México , Diabetes Mellitus Tipo 2 , Diagnóstico , Acessibilidade aos Serviços de Saúde , Saúde na Fronteira , Estados Unidos , Glicemia , Inquéritos Epidemiológicos , Sudoeste dos Estados Unidos , Adulto Jovem , Acessibilidade aos Serviços de Saúde , Acessibilidade aos Serviços de Saúde , Instalações de Saúde , Cobertura do Seguro , Pessoas sem Cobertura de Seguro de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Inquéritos e Questionários , Fatores de Risco , Fatores Socioeconômicos , Populações VulneráveisRESUMO
Population dynamics predict a drastic growth in the number of older minority women, and resultant increases in the number of fractures. Low bone mineral density (BMD) is an important risk factor for fracture. Many studies have identified the lifestyle and health-related factors that correlate with BMD in Whites. Few studies have focused on non-Whites. The objective of the current analyses is to examine the lifestyle, anthropometric and health-related factors that are correlated with BMD in a population based cohort of Caribbean women of West African ancestry. We enrolled 340 postmenopausal women residing on the Caribbean Island of Tobago. Participants completed a questionnaire and had anthropometric measures taken. Hip BMD was measured by DXA. We estimated volumetric BMD by calculating bone mineral apparent density (BMAD). BMD was >10% and >25% higher across all age groups in Tobagonian women compared to US non-Hispanic Black and White women, respectively. In multiple linear regression models, 35-36% of the variability in femoral neck and total hip BMD respectively was predicted. Each 16-kg (one standard deviation (SD)) increase in weight was associated with 5% higher BMD; and weight explained over 10% of the variability of BMD. Each 8-year (1 SD) increase in age was associated with 5% lower BMD. Current use of both thiazide diuretics and oral hypoglycemic medication were associated with 4-5% higher BMD. For femoral neck BMAD, 26% of the variability was explained by a multiple linear regression model. Current statin use was associated with 5% higher BMAD and a history of breast feeding or coronary heart disease was associated with 1-1.5% of higher BMAD. In conclusion, African Caribbean women have the highest BMD on a population level reported to date for women. This may reflect low European admixture. Correlates of BMD among Caribbean women of West African ancestry were similar to those reported for U.S. Black and White women.
Assuntos
Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Humanos , Feminino , Research Support, Non-U.S. Gov't , Densidade Óssea , Inquéritos Epidemiológicos , Estilo de Vida , Pós-Menopausa , Inquéritos e Questionários , Trinidad e Tobago/epidemiologia , Saúde da Mulher , População Negra , Osteoporose Pós-MenopausaRESUMO
Population dynamics predict a drastic growth in the number of older minority women, and resultant increases in the number of fractures. Low bone mineral density (BMD) is an important risk factor for fracture. Many studies have identified the lifestyle and health-related factors that correlate with BMD in Whites. Few studies have focused on non-Whites. The objective of the current analyses is to examine the lifestyle, anthropometric and health-related factors that are correlated with BMD in a population based cohort of Caribbean women of West African ancestry. We enrolled 340 postmenopausal women residing on the Caribbean Island of Tobago. Participants completed a questionnaire and had anthropometric measures taken. Hip BMD was measured by DXA. We estimated volumetric BMD by calculating bone mineral apparent density (BMAD). BMD was >10% and >25% higher across all age groups in Tobagonian women compared to US non-Hispanic Black and White women, respectively. In multiple linear regression models, 35-36% of the variability in femoral neck and total hip BMD respectively was predicted. Each 16-kg (one standard deviation (SD)) increase in weight was associated with 5% higher BMD; and weight explained over 10% of the variability of BMD. Each 8-year (1 SD) increase in age was associated with 5% lower BMD. Current use of both thiazide diuretics and oral hypoglycemic medication were associated with 4-5% higher BMD. For femoral neck BMAD, 26% of the variability was explained by a multiple linear regression model. Current statin use was associated with 5% higher BMAD and a history of breast feeding or coronary heart disease was associated with 1-1.5% of higher BMAD. In conclusion, African Caribbean women have the highest BMD on a population level reported to date for women. This may reflect low European admixture. Correlates of BMD among Caribbean women of West African ancestry were similar to those reported for U.S. Black and White women.
Assuntos
Densidade Óssea , Pós-Menopausa , Saúde da Mulher , Idoso , Idoso de 80 Anos ou mais , Feminino , Inquéritos Epidemiológicos , Humanos , Estilo de Vida , Pessoa de Meia-Idade , Análise de Regressão , Inquéritos e Questionários , Trinidad e Tobago/epidemiologiaRESUMO
BACKGROUND: This study examined whether cardiorespiratory fitness is a risk factor for cardiovascular disease, myocardial infarction, and all-cause mortality in a low- to middle-income Trinidadian community of African, South Asian Indian, and European origin. Those of Indian descent have a distinctively high rate of myocardial infarction. METHODS: The St James Study is a prospective total community survey located in Port-of-Spain, Trinidad, West Indies. A random sample of 626 men aged 35-69 years, without angina of effort, previous myocardial infarction, partial or complete atrio-ventricular conduction defect, complete heart block, or exercise-induced asthma, was used for the assessment of cardiorespiratory fitness by cycle ergometry. Surveillance for morbidity and mortality was maintained for an average of 7.3 years. RESULTS: When the subjects were grouped into those with an age- and fat-free mass-adjusted peak oxygen uptake above and below the mean of 60.4 mmol/min (1.34 l/min), the hazard ratios (below/above) (95% confidence interval) for all-cause mortality, cardiovascular disease incidence, and incidence of myocardial infarction, after allowance for conventional cardiovascular risk factors, were 2.08 (1.23-3.52), 2.13 (1.22-3.69), and 2.36 (0.84-6.67), respectively. For those unable to achieve a level of work requiring an oxygen uptake of 67 mmol/min (1.5 l/min) during progressive exercise, the respective hazard ratios were 3.49 (1.57-7.76), 2.29 (1.21-4.33), and 5.45 (1.22-24.34). Indian ethnicity remained a predictor of myocardial infarction after allowance for cardiorespiratory performance. CONCLUSION: Low cardiorespiratory fitness is a risk factor for cardiovascular disease morbidity and mortality in the low- to middle-income developing community of Trinidad.
Assuntos
Adulto , Pessoa de Meia-Idade , Idoso , Humanos , Masculino , População Negra/estatística & dados numéricos , Antropometria , Pressão Sanguínea , Doenças Cardiovasculares/etnologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/fisiopatologia , Angiopatias Diabéticas/etnologia , Angiopatias Diabéticas/fisiopatologia , Eletrocardiografia , Infarto do Miocárdio/etnologia , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/fisiopatologia , Fatores de Risco , Trinidad e TobagoRESUMO
BACKGROUND: This study examined whether cardiorespiratory fitness is a risk factor for cardiovascular disease, myocardial infarction, and all-cause mortality in a low- to middle-income Trinidadian community of African, South Asian Indian, and European origin. Those of Indian descent have a distinctively high rate of myocardial infarction. METHODS: The St James Study is a prospective total community survey located in Port-of-Spain, Trinidad, West Indies. A random sample of 626 men aged 35-69 years, without angina of effort, previous myocardial infarction, partial or complete atrio-ventricular conduction defect, complete heart block, or exercise-induced asthma, was used for the assessment of cardiorespiratory fitness by cycle ergometry. Surveillance for morbidity and mortality was maintained for an average of 7.3 years. RESULTS: When the subjects were grouped into those with an age- and fat-free mass-adjusted peak oxygen uptake above and below the mean of 60.4 mmol/min (1.34 l/min), the hazard ratios (below/above) (95% confidence interval) for all-cause mortality, cardiovascular disease incidence, and incidence of myocardial infarction, after allowance for conventional cardiovascular risk factors, were 2.08 (1.23-3.52), 2.13 (1.22-3.69), and 2.36 (0.84-6.67), respectively. For those unable to achieve a level of work requiring an oxygen uptake of 67 mmol/min (1.5 l/min) during progressive exercise, the respective hazard ratios were 3.49 (1.57-7.76), 2.29 (1.21-4.33), and 5.45 (1.22-24.34). Indian ethnicity remained a predictor of myocardial infarction after allowance for cardiorespiratory performance. CONCLUSION: Low cardiorespiratory fitness is a risk factor for cardiovascular disease morbidity and mortality in the low- to middle-income developing community of Trinidad.
Assuntos
Doenças Cardiovasculares/etnologia , Causas de Morte , Aptidão Física , Adulto , Idoso , Antropometria , População Negra/estatística & dados numéricos , Pressão Sanguínea , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/fisiopatologia , Angiopatias Diabéticas/etnologia , Angiopatias Diabéticas/fisiopatologia , Eletrocardiografia , Teste de Esforço/métodos , Inquéritos Epidemiológicos , Humanos , Índia/etnologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etnologia , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/fisiopatologia , Consumo de Oxigênio , Fatores de Risco , Trinidad e Tobago/epidemiologia , População Branca/estatística & dados numéricosRESUMO
The presence of antibody to human T-cell leukaemia virus (HTLV-I) has been assessed in 2,143 men and women who represent 83 percent of all adults aged 35 to 69 years resident in a defined urban community in Trinidad. Individuals of African descent had a higher sero-positivity rate (7.0 percent) than those originating from India (1.4 percent), Europe (0 percent) or of mixed descent (2.7 percent). Women were infected more frequently than men, and the prevalence of infection increased with age in both sexes. Sero-positivity rates were significantly increased in adults who lived in housing of poor quality (p less than 0.001) or close to water courses (p less than 0.025). These data and others raise the possibility that one route of HTLV-I transmission may be via insect vectors under particular domestic circumstances.(AU)
Assuntos
Humanos , Adulto , Idoso , Pessoa de Meia-Idade , Habitação , Infecções por Deltaretrovirus/epidemiologia , Fatores Etários , Anticorpos Antivirais/análise , Infecções por Deltaretrovirus/etnologia , Infecções por Deltaretrovirus/transmissão , Trinidad e TobagoRESUMO
OBJECTIVE: To compare the incidence rates of hypertension and non-insulin dependent diabetes mellitus in relation to ethnicity and other characteristics in a rapidly developing community. DESIGN: Prospective surveillance of a total community for five years. SUBJECTS: Cohort of 2491 men and women aged 35 to 69 years (79 percent response), of African, Indian and other (mainly Afro-European) descent. RESULTS: During surveillance, secular increases ocurred in fasting blood glucose concentrations in both sexes and in Body Mass Index (BMI) in men with apparent secular reductions in systolic blood pressure in both sexes. Incidence rates of hypertension did not differ significantly with ethnicity, ranging between 31 and 41 per 1000 person-years in men and between 27 and 32 person-years in women. In men, the incidence of diabetes (per 1000 persons-years) in Indians (24) was significantly higher than in Africans (13) and others (11). In women the diabetic incidence was similar to that for men in Indians (23) and Africans 914), but in others was twice that in men 921). In both sexes, weight gain was an important risk factor for hypertension, whereas risk for diabetes increased with BMI at baseline. The increased risk of diabetes in Indians among men was independent baseline BMI and blood glucose. CONCLUSION: Apart from the increased risk of diabetes in Indians, ethnicity had no significant influence on incidence rates hypertension and diabetes in Trinidad. Secular increases in blood glucose in both sexes and in BMI in men probably contributed to the concurrent increase in mortality from coronary heart disease in this community (AU).
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Diabetes Mellitus Tipo 2/epidemiologia , Hipertensão/epidemiologia , Envelhecimento/fisiologia , Glicemia/metabolismo , Pressão Arterial/fisiologia , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/etiologia , Incidência , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Trinidad e Tobago/epidemiologiaAssuntos
Adulto , Humanos , Masculino , HDL-Colesterol , LDL-Colesterol , Doença das Coronárias , Trinidad e TobagoRESUMO
Looks at the health of Caribbean women aged 15 years and older particularly to mortality patterns, life expectancy, general mortality, major causes of death, cardiovascular diseases and occurrences of malignant neoplasms. (AU)
Assuntos
Humanos , Mortalidade , Doenças Cardiovasculares/epidemiologia , Neoplasias/epidemiologia , Índias Ocidentais , Saúde da MulherRESUMO
Diabetes mellitus and hypertension are major causes of morbidity and mortality in Trinidad and Tobago. Surveillance is important in order to evaluate the impact of intervention programmes aimed at diminishing the effects of these conditions. In this study we investigated whether cause-of-death statements on death certificates could be used for such surveillance. Study subjects were the 160 participants of the population-based "St. James Survey" who died during the ten year follow-up period, and for whom original cause of death statements could be obtained. Sensitivity and specificity were used to assess the accuracy of death certificates at identifying cases and non-cases of diabetes and hypertension. Estimates were calculated, using the "St. James Survey" diagnoses as the "gold standard". When only underlying causes of death were examined, death certificates identified one in three diabetics and less than one in ten hypertensives. When all conditions listed in the cause-of-death statements were considered, two out of every three diabetics and one out of every three hypertensives were correctly identified. Accuracy of reporting did not vary with gender. Sensitivity was higher for participants who died under age 65 years compared with deaths occurring in health care institutions. With the institution of multiple cause coding, continual monitoring, and preservation of documents, death certificates could be a feasible and important surveillance instrument for diabetes mellitus and hypertension in Trinidad and Tobago. (AU)
Assuntos
Atestado de Óbito , Diabetes Mellitus , Hipertensão , Monitoramento Epidemiológico , Trinidad e Tobago , Causas de MorteRESUMO
In a prospective cardiovascular study of 1341 Trinidadian men aged 35-69 years undertaken between 1977 and 1986, the baseline prevalance rates of cardiac and arterial disease and diabetes mellitus were increased in the 118 (8.8 percent) who had been but were no longer regular drinkers. This finding suggested that awareness of these disorders was a discouragement to drinking alcohol. When this group and all with coronary heart disease (CHD) or diabetes at entry were excluded, a significant inverse trend was found between alcohol consumption in the week before recruitment and risk of CHD across the subsequent average follow-up of 7.5 years. Men who had taken 5-14 drinks had about half the CHD risk of those who had had no alcohol, even after allowance for age, ethnicity, smoking, blood pressure and serum cholesterol concentration. The overall morbidity and mortality experience in this community indicated a protective effect of alcohol against CHD, but adverse health consequences from multiple causes in drinkers who were alcohol dependent. (AU)
Assuntos
Humanos , Pessoa de Meia-Idade , Masculino , Consumo de Bebidas Alcoólicas , Doença das Coronárias/prevenção & controle , Nível de Saúde , Fatores Etários , Consumo de Bebidas Alcoólicas , Alcoolismo/epidemiologia , Doença das Coronárias/sangue , Doença das Coronárias/mortalidade , Seguimentos , Estudos Prospectivos , Inquéritos e Questionários , Fatores de Risco , Tabagismo/epidemiologia , Trinidad e Tobago/epidemiologiaRESUMO
Study objective- The aim of the study was to determine whether the inverse association between high density lipoprotein cholesterol concentration and risk of coronary heart disease described in people of European stock was also present in other racial groups. Design- The study was a prospective population survey. Cardiovascular risk factors were examined, including fasting serum lipid estimation (obtained at recruitment). Setting- This was a community based study within a defined survey area in Trinidad. Participants- All men aged between 35 and 69 years within the survey area were identified and followed between 1977 and 1986. Analysis was confined to those of African, Asian Indian, and mixed decent who were free of coronary heart disease at entry (n=960, 69 percent of age eligible men in the survey population). Measurements and main results- 64 men developed coronary heart disease during the study period. A strong inverse curvilinear relation was found between high density lipoprotein cholesterol and coronary heart disease incidence (p<0.005), independent of age or other relevant characteristics including low density lipoprotein cholesterol. Conclusions- A low serum concentration of high density lipoprotein cholesterol is a risk factor for coronary heart disease in non-whites as well as in whites. (AU)