Beatriz Gómez

Trend Analysis of Cancer Mortality and Incidence in Panama, Using Joinpoint Regression Analysis

AbstractCancer is one of the leading causes of death worldwide and its incidence is expected to increase in the future. In Panama, cancer is also one of the leading causes of death. In 1964, a nationwide cancer registry was started and it was restructured and improved in 2012. The aim of this study is to utilize Joinpoint regression analysis to study the trends of the incidence and mortality of cancer in Panama in the last decade.Cancer mortality was estimated from the Panamanian National Institute of Census and Statistics Registry for the period 2001 to 2011. Cancer incidence was estimated from the Panamanian National Cancer Registry for the period 2000 to 2009. The Joinpoint Regression Analysis program, version 4.0.4, was used to calculate trends by age-adjusted incidence and mortality rates for selected cancers.Overall, the trend of age-adjusted cancer mortality in Panama has declined over the last 10 years (−1.12% per year). The cancers for which there was a significant increase in the trend of mortality were female breast cancer and ovarian cancer; while the highest increases in incidence were shown for breast cancer, liver cancer, and prostate cancer. Significant decrease in the trend of mortality was evidenced for the following: prostate cancer, lung and bronchus cancer, and cervical cancer; with respect to incidence, only oral and pharynx cancer in both sexes had a significant decrease. Some cancers showed no significant trends in incidence or mortality.This study reveals contrasting trends in cancer incidence and mortality in Panama in the last decade. Although Panama is considered an upper middle income nation, this study demonstrates that some cancer mortality trends, like the ones seen in cervical and lung cancer, behave similarly to the ones seen in high income countries. In contrast, other types, like breast cancer, follow a pattern seen in countries undergoing a transition to a developed economy with its associated lifestyle, nutrition, and body weight changes.

Assessment of the Possible Association of Air Pollutants PM10, O3, NO2 With an Increase in Cardiovascular, Respiratory, and Diabetes Mortality in Panama City: A 2003 to 2013 Data Analysis

AbstractIn recent years, Panama has experienced a marked economic growth, and this, in turn, has been associated with rapid urban development and degradation of air quality. This study is the first evaluation done in Panama on the association between air pollution and mortality. Our objective was to assess the possible association between monthly levels of PM10, O3, and NO2, and cardiovascular, respiratory, and diabetes mortality, as well as the seasonal variation of mortality in Panama City, Panama.The study was conducted in Panama City, using air pollution data from January 2003 to December 2013. We utilized a Poisson regression model based on generalized linear models, to evaluate the association between PM10, NO2, and O3 exposure and mortality from diabetes, cardiovascular, and respiratory diseases. The sample size for PM10, NO2, and O2 was 132, 132, and 108 monthly averages, respectively.We found that levels of PM10, O3, and NO2 were associated with increases in cardiovascular, respiratory, and diabetes mortality. For PM10 levels ≥ 40 &mgr;g/m3, we found an increase in cardiovascular mortality of 9.7% (CI 5.8–13.6%), and an increase of 12.6% (CI 0.2–24.2%) in respiratory mortality. For O3 levels ≥ 20 &mgr;g/m3 we found an increase of 32.4% (IC 14.6–52.9) in respiratory mortality, after a 2-month lag period following exposure in the 65 to <74 year-old age group. For NO2 levels ≥20 &mgr;g/m3 we found an increase in respiratory mortality of 11.2% (IC 1.9–21.3), after a 2-month lag period following exposure among those aged between 65 and <74 years.There could be an association between the air pollution in Panama City and an increase in cardiovascular, respiratory, and diabetes mortality. This study confirms the urgent need to improve the measurement frequency of air pollutants in Panama.

Quiénes quieren dejar fumar y su disposición a pagar por cesación en Panamá

Resumen: Objetivo: Caracterizar el deseo de cesacion y disposicion al pago por una terapia de abandono de consumo de tabaco. Material y metodos: La fuente de los datos es la Encuesta Mundial de Tabaco en Adultos (EMTA). Se caracterizo la cesacion y la disposicion al pago mediante variables sociodemograficas (SOD) y socioeconomicas (SES). Se realizaron regresiones logisticas para estimar asociaciones. Resultados: El mayor deseo de cesacion se observo en las mujeres, aspecto educativo, empleado no gubernamental e inactivo, zona rural, fumadores ocasionales, ingresos medios y la mayor disposicion al pago, en educacion, mayores de 60 anos, empleado no gubernamental y cuenta propia, zona urbana, fumadores ocasionales e ingreso medio bajo. Conclusiones: Existe una alta relacion entre el deseo de abandono y la disposicion al pago con las variables SOD y SES. Las terapias de cesacion pueden aplicarse en centros de trabajo y exigen un cambio de enfoque en la intervencion.

Analysis of mortality trends due to cardiovascular diseases in Panama, 2001–2014

Objective Cardiovascular diseases (CVDs) are still the leading cause of death worldwide despite the recent decline in mortality rates attributable to CVD in Western Europe and the Americas. The aim of this study is to investigate mortality trends due to ischaemic heart disease (IHD) and stroke in Panama from 2001 to 2014, as well as the mortality differences by sex and age groups. Methods Data were obtained from the National Mortality Register. The International Classification of Diseases 10th revision codes (ICD-10) I20–I25 and I60–I69 were used for IHD and stroke, respectively. Age-adjusted mortality rates were calculated using the world population of the WHO as standard. Trends were analysed using Joinpoint Regression Program and annual percentage changes (APC) were estimated. Results From 2010, the IHD mortality trend began to decline in the whole population of Panama (APC −4.7%, p<0.05). From 2001 to 2014, a decline in the trend for IHD mortality was observed (APC −1.7%, p<0.05) in women, but not in men. Stroke mortality showed a significant annual decline during the study period (APC −3.8%, p<0.05) and it was more pronounced in women (APC −4.5%, p<0.05) than in men (APC −3.3%, p<0.05). Conclusions In Panama, the mortality rates from IHD and stroke have declined in recent years. Better access to healthcare, improved treatment of acute IHD and stroke, low tobacco consumption and better control of hypertension probably account for a significant part of this mortality reduction.

Análisis de los determinantes socioeconómicos del gasto de bolsillo en medicamentos en seis zonas geográficas de Panamá

OBJETIVO Caracterizar el gasto de bolsillo privado en medicamentos en función de los determinantes sociodemográficos y socioeconómicos. MATERIALES Y MéTODOS: La fuente de datos es la Encuesta de Gasto de Bolsillo en Medicamentos de 2014. Se caracterizó el gasto de bolsillo privado mediante variables explicativas sociodemográficas (SOD) y socioeconómicas (SES). Se hizo análisis factorial por componentes principales, regresión logística y lineal simple. RESULTADOS Los Odds Ratio demuestran que la educación y la zona geográfica son determinantes fundamentales que inciden en el gasto de bolsillo. Los medicamentos son productos necesarios, en adición a que el gasto de bolsillo aumenta a un promedio del 2% por cada año de vida cronológica adicional. CONCLUSIONES Existe mayor vulnerabilidad en las zonas más pauperizadas respecto del acceso a medicamentos, en especial en las indígenas e implica un mayor riesgo de gasto catastrófico a menor ingreso ante la mayor prevalencia de enfermedades crónicas.

Factores socioeconómicos asociados con la compra ilegal de productos de tabaco en Panamá

Resumen: Objetivo: Caracterizar la compra ilegal de productos derivados del tabaco y su asociacion con variables sociodemograficas y socioeconomicas. Material y metodos: La fuente de datos es la Encuesta undial de Tabaco en Adultos de 2013. Se caracterizo la compra ilicita mediante variables sociodemograficas (SOD) y socioeconomicas (SES). Se utilizaron modelos de regresion logistica. Resultados: Se encontraron asociaciones de las variables SOD y SES con compra ilegal, particularmente en hombres; grupo etario de 15 a 39 anos, educacion no formal, empleado de gobierno e inactivos, area urbana, fumador diario y en el primer quintil de ingresos. Conclusiones: Las variables SOD y SES influyen en la compra ilicita. Es importante la vigilancia del comercio ilicito en el segmento minorista y la aplicacion efectiva de las normas vigentes.

Chronic Kidney Disease in Panama: Results From the PREFREC Study and National Mortality Trends

Introduction The magnitude of chronic kidney disease (CKD) in Panama has yet to be described. We investigated the association between sociodemographic and cardiovascular exposures with CKD in 2 Panamanian provinces. Further, we analyzed national trends of CKD mortality from 2001 to 2014. Methods Data were derived from Prevalencia de Factores de Riesgo de Enfermedad Cardiovascular (PREFREC [Survey on Risk Factors Associated With Cardiovascular Disease]), a cross-sectional study designed to analyze the prevalence of risk factors associated with cardiovascular disease. Biomarkers of kidney function were measured in 3590 participants. CKD was defined as an estimated glomerular filtration rate (eGFR) of <60 ml/min/1.73 m2 and/or albuminuria ≥30 mg/g creatinine. Odds ratios (ORs) with 95% confidence intervals (CIs) for CKD were calculated using logistic regression. We calculated age-standardized CKD mortality rates in the country using the National Mortality Register. Annual percentage change and 95% CIs were estimated to evaluate the trends over time. Results The prevalence of CKD was 12% (reduced eGFR: 3.3%; albuminuria; 9.9%). CKD was associated with hypertension (OR: 1.8; 95% CI: 1.2−2.7), age 60 years or older (OR: 1.9; 95% CI: 1.2−2.9), and previous myocardial infarction (OR: 2.4; 95% CI: 1.0−5.7), whereas monthly family income was inversely associated with CKD (OR: 0.4; 95% CI: 0.1−0.9) (adjusted). A sustained increase in the trend of CKD mortality was observed from 2001 to 2006, followed by a decreasing trend in subsequent years. Coclé province had the highest adjusted mortality rate. Discussion CKD poses a significant health problem for Panama. Health inequalities and an increase of cardiometabolic risk factors warrant robust epidemiological surveillance, improved diagnosis, and treatment. Further national studies aimed to address geographical disparities are necessary.

Baseline characteristics, survival and direct costs associated to treatment of gastric cancer patients at the National Oncology Institute of Panama from 2012 to 2015: a hospital-based observational study

Objectives Comprehensive epidemiological and economic studies of gastric cancer (GC) in Panama are limited. This study aims to evaluate the association between socioeconomic and clinical variables with survival, describe the survival outcomes according to clinical stage and estimate the direct costs associated to GC care in a Panamanian population with GC. Design and setting A retrospective observational study was conducted at the leading public institution for cancer treatment in Panama. Participants Data were obtained from 611 records of patients diagnosed with gastric adenocarcinoma (codes C16.0–C16.9 of the International Classification of Diseases 10th revision), identified between 1 January 2012 and 31 December 2015. Methods Cox proportional hazards models were used to calculate HRs with 95%  CI to examine associations between the variables and survival. Kaplan-Meier curves were used to assess overall and stage-specific survival. Direct costs (based on 2015 US

Assessment of the Possible Association of Air Pollutants Pm: A 2003 to 2013 Data Analysis10: A 2003 to 2013 Data Analysis, O: A 2003 to 2013 Data Analysis3: A 2003 to 2013 Data Analysis, No: A 2003 to 2013 Data Analysis2: A 2003 to 2013 Data Analysis With an Increase in Cardiovascular, Respiratory, and Diabetes Mortality in Panama City: A 2003 to 2013 Data Analysis

) were calculated per patient using standard costs provided by the institution for hospital admission (occupied bed-days), radiotherapy, surgery and chemotherapy, yielding total and overall mean costs (OMC). A comparison of OMC between groups (sex, social security status, clinical stage) was performed applying the bootstrap method with a t-test of unequal variances. Results An increased risk of dying was observed for patients without social security coverage (HR: 2.02; 95% CI 1.16 to 3.53), overlapping tumours (HR: 1.50; 95% CI 1.02 to 2.22), poorly differentiated tumours (HR: 2.27; 95% CI 1.22 to 4.22) and stage IV disease (HR: 5.54; 95% CI 3.38 to 9.08) (adjusted models). Overall 1-year survival rate was 41%. The estimated OMC of GC care per patient was 4259 US

Assessment of the Possible Association of Air Pollutants Pm: A 2003 to 2013 Data Analysis, O: A 2003 to 2013 Data Analysis, No: A 2003 to 2013 Data Analysis With an Increase in Cardiovascular, Respiratory, and Diabetes Mortality in Panama City: A 2003 to 2013 Data Analysis

. No statistically significant differences were found in OMC between groups. Conclusions Socioeconomic disparities influence GC outcomes and healthcare utilisation. Policies addressing healthcare disparities related to GC are needed, as well as in-depth studies evaluating barriers of access to GC-related services.