RESUMO
BACKGROUND: Longitudinal studies drawn from high-income countries demonstrate long-term associations of early childhood socioeconomic deprivation with increased adiposity in adulthood. However, there are very few data from resource-poor countries where there are reasons to anticipate different gradients. Accordingly, we sought to characterise the nature of the socioeconomic status (SES)-adiposity association in Brazil. METHODS: We use data from the Ribeirao Preto Cohort Study in Brazil in which 9067 newborns were recruited via their mothers in 1978/79 and one-in-three followed up in 2002/04 (23-25years). SES, based on family income (salaries, interest on savings, pensions and so on), was assessed at birth and early adulthood, and three different adiposity measures (body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR)) ascertained at follow-up. The association between childhood SES, adult SES and social mobility (defined as four permutations of SES in childhood and adulthood: low-low, low-high, high-low, high-high), and the adiposity measures was examined using linear regression. RESULTS: There was evidence that the association between SES and the three markers of adiposity was modified by gender in both adulthood (P<0.02 for all outcomes) and childhood SES (P<0.02 for WC and WHR). Thus, in an unadjusted model, linear regression analyses showed that higher childhood SES was associated with lower adiposity in women (coefficient (95% confidence intervals) BMI: -1.49 (-2.29,-0.69); WC: -3.85 (-5.73,-1.97); WHR: -0.03 (-0.04,-0.02)). However, in men, higher childhood SES was related to higher adiposity (BMI: 1.03 (0.28,-1.78); WC: 3.15 (1.20, 5.09); WHR: 0.009 (-0.001, 0.019)) although statistical significance was not seen in all analyses. There was a suggestion that adult SES (but not adult health behaviours or birthweight) accounted for these relationships in women only. Upward mobility was associated with protection against greater adiposity in women but not men. CONCLUSION: In the present study, in men there was some evidence that both higher childhood and adulthood SES was related to a higher adiposity risk, while the reverse gradient was apparent in women.
Assuntos
Índice de Massa Corporal , Obesidade/epidemiologia , Classe Social , Adiposidade , Adulto , Fatores Etários , Biomarcadores/sangue , Peso ao Nascer , Brasil/epidemiologia , Estudos de Coortes , Feminino , Comportamentos Relacionados com a Saúde , Inquéritos Epidemiológicos , Humanos , Estudos Longitudinais , Masculino , Obesidade/sangue , Obesidade/prevenção & controle , Dinâmica Populacional , Vigilância da População , Fatores de Risco , Mobilidade Social , Fatores Socioeconômicos , Fatores de TempoRESUMO
INTRODUCTION: Prevalence of obesity is rising in Latin America and increasingly affecting socially disadvantaged groups, particularly women. Conditional cash transfers are recently established welfare interventions in the region. One, Familias en Accion, transfers â¼20% of average monthly income to women in Colombia's poorest families. Previous work has found that families buy more food as a result. We tested the hypothesis that participation in Familias would be associated with increasing body mass index (BMI) in participating women. METHODS: Women from participating areas and control areas (matched on environmental and socioeconomic criteria) were surveyed in 2002 and 2006. Pregnant, breast-feeding or women aged <18 or with BMI <18.5 kg m(-2) were excluded. The sample comprises 835 women from control and 1238 from treatment areas. Because some treatment areas started Familias shortly before baseline data collection, a dummy variable was created that identified exposure independent of time point or area. Follow-up was 61.5%. BMI was measured by trained personnel using standardized techniques. Overweight was defined as BMI ≥ 25 kg m(-2) and obesity as ≥ 30 kg m(-2). The effect of Familias was estimated using linear regression (or logistic regression for dichotomous outcomes) in a double-difference technique, controlling for several individual, household and area characteristics, including parity and baseline BMI, using robust standard-errors clustered at area-level in an intention-to-treat analysis. RESULTS: At baseline, women's mean age was 33.3 years and mean BMI 25.3 kg m(-2); 12.3% women were obese. After adjustment, exposure to Familias was significantly associated with increased BMI (ß=0.25; 95% confidence interval (CI) 0.03, 0.47; P=0.03). Age (ß=0.09; 95% CI 0.06, 0.13; P<0.001) and household wealth (ß=0.78; 95% CI 0.41, 1.15; P<0.001) were also positively associated with BMI. Familias was also associated with increased odds of obesity (odds ratio (OR)=1.27; 95% CI 1.03, 1.57; P=0.03), as was age (OR=1.04; 95% CI 1.02, 1.06; P=0.001). CONCLUSION: Conditional cash transfers to poor women in Colombia are independently associated with increasing BMI and obesity risk. Although conditional cash transfers are generally regarded as popular and successful schemes, parallel interventions at individual, household and community level are needed to avoid unanticipated adverse outcomes.
Assuntos
Serviços de Saúde Comunitária/estatística & dados numéricos , Financiamento Governamental , Programas Governamentais , Promoção da Saúde , Obesidade/epidemiologia , Pobreza , Adulto , Estudos de Coortes , Colômbia/epidemiologia , Feminino , Promoção da Saúde/economia , Promoção da Saúde/métodos , Humanos , Obesidade/etiologia , Obesidade/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde , Pobreza/estatística & dados numéricos , Prevalência , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Seguridade SocialRESUMO
BACKGROUND: Psychosocial factors are associated with the etiology and prognosis of coronary heart disease (CHD) in White populations; however, previous studies have not examined the distribution of psychosocial factors in ethnic groups with coronary rates higher (South Asian) and lower (Afro-Caribbean) than those of Whites. STUDY OBJECTIVE: To determine whether ethnic differences in psychosocial risk factors parallel those in CHD mortality. DESIGN: Cross-sectional survey. SETTING: 20 civil service departments in London. PARTICIPANTS: 8973 White, 577 South Asian, and 360 Afro-Caribbean office-based civil servants, aged 35-55 years. OUTCOME MEASURES: Minor psychiatric morbidity (General Health Questionnaire), social supports (marital status, social networks, negative aspects of support, confiding/emotional support, social support at work), psychosocial work characteristics (job control, effort-reward imbalance), hostility levels and presence of Type A personality. RESULTS: South Asians, compared to Whites, had more depression, higher negative supports, less social support at work, less job control, more effort-reward imbalance and higher levels of hostility, when adjusting for age and sex. Afro-Caribbeans, compared to Whites, had lower minor psychiatric morbidity and lower Type A scores. The remaining psychosocial factors showed either no ethnic differences in distribution, or differences contrary to those predicted from coronary event rates. Adjustment for employment grade made little difference to these associations. CONCLUSION: Among South Asians, the majority of whom were Indian, the distribution of psychosocial factors was consistent with ethnic differences in coronary rates; the pattern for Afro-Caribbeans was less consistent. Further research is required to test the extent to which psychosocial factors predict coronary events within ethnic groups and to characterize better psychosocial measures.
Assuntos
Doença das Coronárias/psicologia , Adulto , Sudeste Asiático/etnologia , Estudos de Coortes , Intervalos de Confiança , Doença das Coronárias/epidemiologia , Doença das Coronárias/etnologia , Estudos Transversais , Feminino , Hostilidade , Humanos , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Escalas de Graduação Psiquiátrica , Fatores de Risco , Apoio Social , Personalidade Tipo A , Índias Ocidentais/etnologia , População Branca/estatística & dados numéricosRESUMO
OBJECTIVE: To determine the risk of maternal mortality in immigrants to England and Wales. DESIGN: Analysis of death registrations, 1970-1985, by country of birth. SETTING: England and Wales. POPULATION: Women dying in England and Wales during pregnancy, childbirth or the puerperium, or dying from malignant tumour of the placenta. MAIN OUTCOME MEASURES: The risk of dying in pregnancy, childbirth or the puerperium, adjusted for age and year of death, and the risk of cause-specific death, adjusted for age, in immigrants compared with women born in England and Wales. RESULTS: Women born in West Africa (relative risk 10.3; 95% CI 8.0-13.2) and the Caribbean (4.6; 3.8-5.7) were at very elevated risk of maternal death and of the main causes of death. Women from Southern Asia (1.6; 1.3-2.0) and "Europe and the USSR' (1.7; 1.2-2.3) were at moderate risk. Adjustment for year of death increased the estimates of risk and women born in the "Rest of the World' and Scotland were at significantly elevated risk. CONCLUSIONS: An increased incidence of obstetric conditions in immigrant groups may account for the elevated risk but it is also possible that differences in care may account for some of the additional risk. The pattern of increased risk does not appear to be explicable by the parity or social class distribution of immigrants as far as data are available on these. Research is required into the aetiology of the differential incidence of obstetric disease. The collection of routine mortality data which include maternal reproductive and social factors would elucidate the significance of such factors to maternal health. Further investigation into possible differences in the process of antenatal care between immigrants and non-immigrants is required, and into whether this affects the risk of maternal mortality.
Assuntos
Emigração e Imigração , Mortalidade Materna , Adulto , África Ocidental/etnologia , Ásia/etnologia , Inglaterra/epidemiologia , Europa (Continente)/etnologia , Feminino , Humanos , Gravidez , Medição de Risco , Fatores de Risco , Federação Russa/etnologia , Escócia , País de Gales/epidemiologia , Índias Ocidentais/etnologiaRESUMO
The prevalence of hypertension is particularly high in people of black African descent throughout the world, and the consequences of hypertension, such as hypertensive heart and renal disease and stroke, are also more common. But there is little consensus on whether hypertensive retinopathy follows a similar pattern. We determined the prevalence of hypertensive retinopathy and its relationships with resting and ambulatory blood pressure in a population study of Afro-Caribbeans and Europeans aged 40 to 64 years in London, UK. Retinal photographs of 651 participants were graded for hypertensive retinopathy. Age- and sex-standardized prevalence of retinopathy was 11 percent (95 percent confidence interval, 8 percent to 14 percent) in Europeans and 21 percent (95 percent confidence interval, 16 percent to 26 percent) in Afro-Caribbeans (P<.0010, respectively. This ethnic difference in prevalence was greatest in normotensive women (8 percent in Europeans versus 20 percent in Afro-Caribbeans, P<.001). Resting systolic pressure was 8 mm Hg higher in normotensive Afro-Caribbean compared with European women, but this could not fully account for the ethnic difference in the prevalence of retinopathy. Examination of the different relationships of age and resting and ambulatory blood pressures with hypertensive retinopathy showed that these relationships were strongest in European women and weakest in Afro-Caribbean women. We concluded that hypertensive retinopathy is more common in Afro-Caribbeans, particularly women, and that ethnic differences in resting blood pressure cannot fully account for this. The relatively weak relationship between resting and ambulatory blood pressures and retinopathy in Afro-Caribbeans suggests of hypertensive retinopathy in this group (AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Hipertensão/complicações , Doenças Retinianas/epidemiologia , Fatores Etários , Prevalência , Doenças Retinianas/etiologia , Fatores de Risco , Região do Caribe , Europa (Continente)RESUMO
Afro-Caribbeans have low mortality rates from coronary heart disease, despite a high prevalence of diabetes mellitus. We examined 1166 Afro-Caribbean and European men and women aged 40-64 years in a community survey in London, UK. Prevalence of glucose intolerance (combining impaired glucose tolerance, new and known diabetes) was 31 percent in Afro-Caribbeans and 14 percent in Europeans (p<0.001). In men, the prevalence of probable coronary heart disease was 6 percent in Afro-Caribbeans and 13 percent in Europeans (p<0.01). Triglyceride was lower in Afro-Caribbeans than Europeans; in men, HDL cholesterol was higher. Afro-Caribbeab men were less centrally obese, while Afro-Caribbean women were more centrally obese than their European counterparts. Fasting and 2-h insulin levels were higher in Afro-Caribbeans than Europeans. Glucose intolerance was associated with high triglyceride, low HDL cholesterol and central obesity in European but not in Afro-Caribbean men. In Europeans, fasting triglyceride was 1.49 mmol/l in normoglycaemic and 1.89 mmol/l in glucose intolerant men (p<0.05), in Afro-Caribbean men triglyceride was 1.08 and 1.22 mmol/l, respectively. Waist hip ratio was 0.94 in normoglycaemic, and 0.98 in glucose intolerant European men (p<0.001). In Afro-Caribbean men, waist hip ratio was 0.93 in both groups. At each level of insulin, glucose or central obesity, triglyceride was lower in Afro-Caribbean men and women than in Europeans. We speculate that despite high insulin levels, Afro-Caribbeans have a favourable lipoprotein pattern which persists in the presence of glucose intolerance, and may be related to body fat distribution. This could begin to explain their low rates of coronary heart disease (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Doença das Coronárias/epidemiologia , Intolerância à Glucose/epidemiologia , Apolipoproteínas B/sangue , Região do Caribe/etnologia , Colesterol/sangue , Doença das Coronárias/mortalidade , Diabetes Mellitus/epidemiologia , Europa (Continente) , Teste de Tolerância a Glucose , Insulina/sangue , Lipoproteínas , HDL-Colesterol/sangue , Fatores Etários , Fatores Sexuais , Prevalência , Dobras CutâneasRESUMO
To investigate why mortality from stroke in people of Afro-Caribbean origin is twice the average for England and Wales, we examined 1166 European and Afro-Caribbean people in London. Age-standardized median systolic blood pressure was 6 mm Hg higher (128 versus 122 mm Hg) in Afro-Caribbean than European men and 17 mm Hg higher (135 versus 118 mm Hg) in Afro-Caribbean than European women. Migrants from West Africa and the Caribbean had similar blood pressures. Body mass index was higher in Afro-Caribbean than European women, accounting for 4 mm Hg of the systolic difference. Diabetes prevalence was 16% in Afro-Caribbeans and 5% in Europeans (P < .001), accounting for 1 mm Hg of the difference in systolic pressure in men and 2 mm Hg in women. In participants not taking antihypertensive medication, mean fall in ambulatory systolic pressure between daytime and nighttime, adjusted for resting blood pressures, was 24 mm Hg in Europeans and 18 mm Hg in Afro-Caribbeans (P = .05), and percent day-night fall in systolic blood pressure adjusted for resting systolic pressure was 17% in Europeans and 12% in Afro-Caribbeans (P < .05). This difference persisted when men and women and normotensive and hypertensive individuals were examined separately. We estimate that the differences in blood pressure between Afro-Caribbeans and Europeans may be enough to account for ethnic differences in stroke mortality in women but not men. The reasons for the high prevalence of hypertension and related morbidity in this and other populations of African descent remain to be established.
Assuntos
Pressão Sanguínea , Hipertensão/etnologia , Adulto , África Ocidental/etnologia , Fatores Etários , População Negra , Determinação da Pressão Arterial , Índice de Massa Corporal , Ritmo Circadiano , Complicações do Diabetes , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etnologia , Europa (Continente)/etnologia , Feminino , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Prevalência , Fatores Sexuais , Índias Ocidentais/etnologia , População BrancaRESUMO
To investigate why mortality from stroke in people of Afro-Carribean origin is twice the average for England and Wales, we examined 11166 Europeans and Afro-Caribbean people in London. Age-standardized median systolic blood pressure was 6mm Hg higher (128 versus 122mm Hg) in Afro-Caribbean than European men and 17mm Hg higher (135 versus 118 mm Hg) in Afro-Carribean than European women. Migrants from West Africa and the Caribbean had similar bloood pressure. Body mass index was higher in Afro-Caribbean than European women, accounting for 4mm Hg of the systolic difference. Diabetes prevalence was 16 percent in Afro-Caribbeans and 5 percent in Europeans (P < .001), accounting for 1mm Hg of the diffference in systolic pressure in men and 2mm Hg in women. In participants not taking antihypertensive medication, mean fall in ambulatory systolic pressure between daytime and nighttime, adjusted for resting blood pressures, was 24 mm H g in Eropeans and 18 mm Hg in Afro-Caribbeans (P = 015), and percent day-night fall in systolic blood pressure adjusted for resting systolic pressure was 17 percent in Europeans and 12 percent Afro-Caribbeans (P < .05). This difference persisted when men and women and normotensive and hypertensive individuals were examined separately. We estimate that the differences in blood pressure between Afro-Caribbean and Europeans may be enough to account for ethnic differences in stroke mortality in women but not men. The reasons for the high prevalence of hypertension and related morbidity in this and other populations of African descent remain to be established (AU)
Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Masculino , Feminino , Pressão Arterial , Hipertensão/etnologia , África Ocidental/etnologia , Fatores Etários , Determinação da Pressão Arterial , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etnologia , Europa (Continente)/etnologia , Hipertensão/complicações , Hipertensão/epidemiologia , Índice de Massa Corporal , Ritmo Circadiano , Londres/epidemiologia , Monitorização Fisiológica , Prevalência , Fatores Sexuais , Índias Ocidentais/etnologiaRESUMO
Cancer mortality during 1970-85 of immigrants from East and West Africa and the Caribbean to England and Wales is described. Overall cancer mortality was raised in West African males (RR 1.38, 95% CI 1.25-1.54), and non-significantly raised in West African females (RR 1.14, 0.96-1.37) compared to mortality in the England and Wales-born population. Much of the increased risk was due to very high rates of liver cancer in males (RR 31.6, 23.8-41.9), but rates were also raised for a wide range of other cancers in each sex. Only lung and brain cancer had significantly decreased mortality. In East Africans, overall cancer mortality was low in males (RR 0.63, 0.56-0.70), and in females (RR 0.80, 0.72-0.89). Mortality was significantly low for cancers of the stomach, pancreas and testis, and Hodgkin's disease in males, for cervical cancer in females, and for lung cancer and melanoma in both sexes. Cancer sites with significantly raised mortality included oropharyngeal cancer, leukaemia, and multiple myeloma in both sexes. In Caribbean immigrants overall cancer rates were significantly low in males (RR 0.71, 0.68-0.74) and in females (RR 0.76, 0.73-0.80). Mortality was significantly low for many cancers including colorectal, lung, testis and brain cancers. Mortality was significantly raised only for cancer of the prostate in males, of the placenta in females, and of the liver, non-Hodgkin's lymphoma and multiple myeloma in both sexes. Overall, mortality was high from prostatic cancer and liver cancer, and was low from brain cancer, in predominantly ethnic African immigrant groups. Both East and West African immigrants had raised rates of leukaemia. All of the migrant groups had high rates of multiple myeloma and low rates of testicular, ovarian and lung cancer. Genetic and environmental factors that may contribute to these patterns are discussed.
Assuntos
Neoplasias/mortalidade , Migrantes/estatística & dados numéricos , Adolescente , Adulto , África/etnologia , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Neoplasias do Sistema Digestório/mortalidade , Inglaterra/epidemiologia , Feminino , Neoplasias dos Genitais Femininos/mortalidade , Neoplasias dos Genitais Masculinos/mortalidade , Humanos , Lactente , Recém-Nascido , Leucemia/mortalidade , Neoplasias Pulmonares/mortalidade , Linfoma/mortalidade , Masculino , Pessoa de Meia-Idade , Neoplasias Faríngeas/mortalidade , Classe Social , Fatores de Tempo , Neoplasias Urológicas/mortalidade , País de Gales/epidemiologia , Índias Ocidentais/etnologiaRESUMO
Many epidemiologic investigations including case-control and cohort studies have attempted to evaluate the association between the use of oral contraceptives and cardiovascular disease. These studies were largely carried out over a decade ago and in general demonstrated that oral contraceptive use did increase the risk of various diseases. The majority of these studies had insufficient power however, to evaluate several critical associated questions including the optimal composition, dosage and duration of the oral contraceptive used, and currently available data are often inconsistent and conflicting. Since the majority of these epidemiologic studies were carried out, contraceptive practices have changed, as has the composition and dosages of the drugs used. In attempt to evaluate the risks associated with current prescribing practices using currently available oral contraceptives amongst women from all around the world, (hiherto virtually no data are available from outside Europe and the USA) an international multicenter case-control study was begun in 1989. The potential for this study to supply the answers to the many important outstanding questions is discussed. Assumig strict attention to good methodology and study design, very large studies are required to provide many of the missing answers. (AU)
Assuntos
Feminino , Humanos , Adulto , Anticoncepcionais Orais , Doenças Cardiovasculares , Fatores de RiscoRESUMO
PIP: This paper reports the results of a systematic review of mortality among immigrant groups in England and Wales. Mortality rates in 1970-72 were compared with rates both in the countries of origin and in England and Wales. All-cause male mortality was lower in immigrants from italy, the Caribbean, and Poland than in the countries of origin, suggesting a selection effect among migrants. The opposite patttern was noted for imigrants from Ireland, however, indicating social and health disadvantages may be a stimulus to migration. The high mortality from tuberculosis in immigrants from the indian subcontinent and Ireland, low mortality from ischemic heart disease and high mortality from cerebrovascular disease in Caribbean men, and low mortality from cancer of the lung and intestine in all but Irish men reflect the influence of the migrants' original country. A possible influence of the host country on determining disease rates is seen in adaptation of immigrant mortality ratios toward the England and Wales average. For example, immigrants from several countries analyzed had ischemic heart disease mortalty ratios intermediate between those for the original country and for England and Wales. In addition, British people born in the Indian subcontinent showed a mortality pattern intermediate between that of the Indians and the England and Wales average, supporting the argument that environmental rather than genetic determinants may be involved in the principal chronic diseases. Particularly high mortality from complications of pregnancy and childbirthwas noted in indian and Caribbean immigrants, indicating that there may be social and cultural barriers to the receipt of adequate medical care. Finally, social class differences did not account for mortality differences among immigrant groups. Mortality was higher for the Irish than the English or Welsh in each social class group, which suggests there are cultural influences on mortality that act independently of social class influences.^ieng
Assuntos
Emigração e Imigração , Mortalidade , Adaptação Psicológica , Inglaterra , Feminino , Humanos , Índia/etnologia , Irlanda/etnologia , Itália/etnologia , Masculino , Morbidade , Polônia/etnologia , Classe Social , País de Gales , Índias Ocidentais/etnologiaRESUMO
Comparing the distributions of blood pressure in different populations it has been found that the log-normal distribution gave the best summary of the data. The geometric mean and the coefficient of variation of the underlying blood pressure distribution were the most informative statistics. Using this blood pressure distribution, a model is discussed for the change in blood pressure with age and between populations. These changes are consistent with an environmental factor, such as salt intake, affecting the position of the mean of the blood pressure distribution and with a gradient of susceptibility within a population.