Belén Zorrilla

Factores de riesgo cardiovascular en España en la primera década del siglo xxi: análisis agrupado con datos individuales de 11 estudios de base poblacional, estudio DARIOS ☆

INTRODUCTION AND OBJECTIVES To estimate the prevalence of cardiovascular risk factors in individuals aged 35-74 years in 10 of Spains autonomous communities and determine the geographic variation of cardiovascular risk factors distribution. METHODS Pooled analysis with individual data from 11 studies conducted in the first decade of the 21st century. The average response rate was 73%. Lipid profile (with laboratory cross-validation), glucose level, blood pressure, waist circumference, height, and weight were measured and standard questionnaires administered. Age-standardized prevalence of smoking, diabetes, hypertension, dyslipidemia, and obesity in the European population were calculated. Furthermore, the coefficient of variation between component studies was determined for the prevalence of each risk factor. RESULTS In total, 28,887 participants were included. The most prevalent cardiovascular risk factors were high blood pressure (47% in men, 39% in women), total cholesterol ≥ 250 mg/dL (43% and 40%, respectively), obesity (29% and 29%, respectively), tobacco use (33% and 21%, respectively), and diabetes (16% and 11%, respectively). Total cholesterol ≥ 190 and ≥ 250 mg/dL were the respective minimum and maximum coefficients of variation (7%-24% in men, 7%-26% in women). Average concordance in lipid measurements between laboratories was excellent. CONCLUSIONS Prevalence of high blood pressure, dyslipidemia, obesity, tobacco use and diabetes is high. Little variation was observed between autonomous communities in the population aged 35-74 years. However, presence of the most prevalent cardiovascular risk factors in the Canary Islands, Extremadura and Andalusia was greater than the mean of the 11 studies.

Comparación entre encuestas telefónicas y encuestas «cara a cara» domiciliarias en la estimación de hábitos de salud y prácticas preventivas

Objetivo: En este estudio se examina la influencia del metodo de encuesta, telefonica y «cara a cara» domiciliaria, sobre la estimacion de los factores de riesgo para la salud asociados al comportamiento y la realizacion de practicas preventivas. Material y metodo: El mismo cuestionario fue administrado en 2 muestras independientes de poblacion de 18-64 anos residente en el municipio de Madrid. Una muestra (n = 1.391) realizo la entrevista telefonica y la otra (n = 739), la entrevista «cara a cara» domiciliaria. Se compararon los resultados de las 2 muestras para 28 variables relacionadas con la antropometria, la actividad fisica, el consumo de alimentos, el consumo de tabaco y alcohol, las practicas preventivas y la accidentabilidad. Resultados: La muestra telefonica obtuvo una mayor tasa de no contactos (31,8 frente a 22,2%) pero un mayor grado de cooperacion que la muestra con entrevista «cara a cara» (83 frente a 74%). En total, 19 de las 28 variables mostraron una variacion relativa entre ambas encuestas < 10%, en 8 variables las diferencias se encontraban entre el 10 y el 20%, y 1 supero el 20%. Solo en 4 variables (sedentarismo en el tiempo libre, consumo de verdura, abandono del consumo de tabaco y medicion del colesterol) las diferencias fueron estadisticamente significativas, con una variacion relativa del 6,1% (p < 0,01), 10% (p < 0,001), 36,7% (p < 0,01) y 8,6% (p < 0,01), respectivamente. El coste global de la entrevista telefonica ha sido la mitad de la domiciliaria «cara a cara». Conclusiones: Los resultados de las encuestas telefonica y «cara a cara» domiciliaria fueron muy similares. El menor coste de la encuesta telefonica la convierte en una buena alternativa para la investigacion de salud publica que requiera la recogida de datos por entrevista.

[Telephone versus face-to-face household interviews in the assessment of health behaviors and preventive practices].

OBJECTIVE This study examines the influence of the interview method (telephone or face-to-face in households) on the assessment of health behaviors and preventive practices. MATERIAL AND METHOD The same questionnaire was completed by two independent samples of the population aged 18-64 years living in the municipality of Madrid. One sample (n = 1,391 subjects) completed the questionnaire by telephone interview and the other (n = 739) by face-to-face interview in households. The results of the two samples for 28 variables related to anthropometry, physical activity, food consumption, tobacco and alcohol use, preventive practices and injuries were compared. RESULTS The telephone sample had a higher rate of failed contact (31.8% vs. 22.2%) but a greater degree of cooperation than the sample for the face-to-face interview (83.0% vs. 74.0%). In total, 19 of the 28 variables showed a relative variation of less than 10% between the two surveys; the differences found were between 10 and 20% for eight variables and were higher than 20% for one variable. Differences were statistically significant for only four variables (sedentary leisure time, consumption of vegetables, giving up smoking and cholesterol measurement), with a relative variation of 6.1% (p < 0.01), 10% (p < 0.001), 36.7% (p < 0.01) and 8.6% (p < 0.01), respectively. The total cost of the telephone interview was half that of the face-to-face household interview. CONCLUSIONS The results of both surveys were very similar. Because of its lower cost, the telephone interview is a good option in public health research when data collection by interview is required.

Actividad física de tiempo libre en un país mediterráneo del sur de Europa: adherencia a las recomendaciones y factores asociados

Introduccion y objetivos. Examinar en adultos de la Comunidad de Madrid la adecuacion de la actividad fisica en tiempo libre (AFTL) a las recomendaciones e identificar factores asociados. Metodos. Encuesta telefonica a 12.037 personas, representativa de la poblacion de 18-64 anos de Madrid. La AFTL se calculo en MET-h/semana mediante un cuestionario de frecuencia y duracion de AFTL. Se comparo con la recomendacion de realizar actividad al menos moderada ? 150 min/semana, o vigorosa ? 60 min/semana. Los factores asociados al cumplimiento se identificaron mediante regresion logistica. Resultados. La media de AFTL fue 17,3 (intervalo de confianza [IC] del 95%, 16,9-17,7) MET-h/semana y un 28,8% (IC del 95%, 28%-29,7%) alcanzo la recomendacion. La AFTL recomendada fue mas frecuente en varones que en mujeres (odds ratio [OR] = 2,41; IC del 95%, 2,20-2,64). Comparando con los mas jovenes, la adherencia disminuyo gradualmente con la edad hasta los 60-64 anos, donde la OR fue 0,20 (IC del 95%, 0,15-0,25). Respecto a los sujetos sin estudios, los universitarios siguieron mas frecuentemente la recomendacion (OR = 2,28; IC del 95%, 1,82-2,87). Las personas obesas tuvieron menos probabilidad que los normopesos de realizar la AFTL recomendada (OR = 0,49; IC del 95%, 0,40-0,61). Las personas con actividad laboral de baja intensidad se adhirieron a la recomendacion con mas frecuencia que las de ocupacion sedentaria (OR = 1,21; IC del 95%, 1,10-1,34). Conclusiones. La mayoria de los adultos de Madrid no siguio la recomendacion de AFTL. La adherencia fue menor en mujeres, al aumentar la edad, con menor nivel de estudios y en obesos, mientras que fue mayor en personas con ocupaciones que requieren baja intensidad fisica.

Intimate partner violence: last year prevalence and association with socio-economic factors among women in Madrid, Spain

BACKGROUND Intimate partner violence (IPV) is a public health problem with significant consequences on womens health. This study estimates the prevalence of intimate partner violence by type among Madrids female population and assesses the association with socio-economic variables. METHODS We conducted a cross-sectional study in 2004, 2136 women aged 18-70 years, living in the Madrid region with a partner or who had been in contact with an ex-partner in the previous year, were interviewed by telephone. The questionnaire used to measure past-year intimate partner violence, consisted of a Spanish translation of the psychological and sexual violence module of the French National Survey on Violence against Women, and the physical violence module of the Conflict Tactics Scale-1. To assess the association with socio-economic factors, logistic regression models were fitted. RESULTS About 10.1% [confidence interval (CI) 8.9-11.5] of the women had suffered some type of IPV in the previous year. 8.6% (CI 7.4-9.8) experienced psychological violence, 2.4% (CI 1.8-3.1) physical violence and 1.1% (CI 0.68-1.6) sexual violence; the prevalence of psychological-only violence (non-physical/non-sexual) was 6.9% (CI 5.8-8.0). Factors associated with psychological-only violence were divorced or separated status and Group III (clerical workers; supervisors of manual workers) or V (unskilled manual workers) occupation. Unemployment and divorced or separated status were associated with physical violence. CONCLUSIONS Spanish women in our study, experienced past year partner violence at a similar level as in other industrialized countries. Unemployment and low occupational status are associated with physical and psychological-only violence, respectively.

Clustering of behavioural risk factors and their association with subjective health

Objetivos: Describir la agregacion de factores de riesgo relacionados con el comportamiento en la poblacion adulta de la Comunidad de Madrid y evaluar la asociacion del grado de agregacion de dichos factores con la salud subjetiva suboptima. Metodos: Los datos proceden del Sistema de Vigilancia de Factores de Riesgo asociados a Enfermedades No Transmisibles (SIVFRENT). Las relaciones entre el consumo de tabaco, el consumo de alcohol de riesgo, el sedentarismo en tiempo libre y la dieta desequilibrada fueron estudiadas en 16.043 personas de 18 a 64 anos, y se compararon las proporciones observadas respecto a las esperadas. Mediante un analisis de regresion logistica se estimo la asociacion entre la agregacion de factores de riesgo y la salud percibida suboptima (regular, mala y muy mala). Resultados: Cerca del 20% de los sujetos presentan 3 o 4 factores de riesgo simultaneamente. La mayoria de combinaciones de 3 factores de riesgo son superiores a las esperadas, destacando la agregacion de los 4 factores con un cociente observado/esperado de 2,15 (IC del 95%, 1,93-2,38) en varones y de 2,96 (IC del 95%, 2,46-3,46) en mujeres. En ambos sexos, el factor individual que mas se asocia al resto de factores de riesgo es el tabaco. La agregacion de factores de riesgo es mas frecuente en varones, en edades jovenes y en el nivel educativo bajo. En comparacion con los que carecen de los 4 factores de riesgo, los que presentan simultaneamente 3 o 4 de ellos tienen con mayor frecuencia una salud percibida suboptima (OR = 2,49; IC del 95%, 1,59-3,90 en varones y OR = 1,96; IC del 95%, 1,29-2,97 en mujeres). Conclusiones: Los factores de riesgo ligados al comportamiento se agregan, y esta acumulacion es superior en varones, en personas jovenes y con bajo nivel de estudios. Un mayor grado de agregacion se asocia a mayor frecuencia de salud percibida suboptima.

Vigilancia de los factores de riesgo de las enfermedades no transmisibles mediante encuesta telefónica: resultados de la Comunidad de Madrid en el período 1995-2003

Objective: To illustrate -for the first time with Spanish datathe usefulness of telephone-interview-based surveillance of non-communicable diseases risk factors for the purpose of drawing up public health policies. Methods: We analysed information from the Non-Communicable Disease Risk Factor Surveillance System (Sistema de Vigilancia de Factores de Riesgo asociados a Enfermedades No Transmisibles- SIVFRENT) for the period 1995-2003. This system is based on monthly telephone interviews covering a representative population sample, aged 18-64 years. 18,049 interviews were conducted for the whole period. Indicators of overweight and obesity, sedentary lifestyle, diet, tobacco and alcohol consumption, preventive practices, accidents and injuries, and road safety were calculated. The time trend was estimated using average annual prevalence ratios, obtained from generalised linear models with binomial family and logarithmic link. Results: Among men, the changes of greatest magnitude corresponded to an increase in overweight and obesity, which registered a relative annual rise of 3.7%, and a decrease in dieting (‐3%), high alcohol consumption (‐6.1%) and non-use of safety belts (‐4%). Among women, there was a marked increase in overweight and obesity (3.3%), cessation of smoking (3.1%) and recourse to mammograms (6.4%), and a decrease in dieting (‐4.1%) and non-use of safety belts (‐4.5%). Conclusions: Although important progress was observed in a number of indicators, such as tobacco and alcohol consumption, road safety and the undertaking of preventive practices, the situation worsened in others, i.e., fundamentally the increase in overweight and obesity.

Leisure-Time Physical Activity in a Southern European Mediterranean Country: Adherence to Recommendations and Determining Factors

INTRODUCTION AND OBJECTIVES To determine whether adults in Madrid, Spain adhere to leisure-time physical activity (LTPA) recommendations and to identify factors associated with adherence. METHODS A telephone survey of 12,037 individuals, representative of the Madrid population aged 18-64 years, was conducted. The LTPA level was quantified in metabolic equivalent (MET) hours per week from answers to a questionnaire on the frequency and duration of LTPA. This level was compared with the recommendation to engage in at least moderate activity >or=150 min/week or vigorous activity >or=60 min/week. Factors associated with adherence to the recommendation were identified using logistic regression analysis. RESULTS The mean LTPA level was 17.3 MET-hours/ week (95% confidence interval [CI], 16.9-17.7 MET-hours/week) and 28.8% (95% CI, 28%-29.7%) adhered to the recommendation. The recommended level was achieved more frequently in men than women (odds ratio [OR]=2.41; 95% CI, 2.20-2.64). In comparison with younger individuals, adherence decreased gradually with age until 60-64 years, when the OR was 0.20 (95% CI, 0.15-0.25). Compared with less well-educated individuals, the university-educated were more likely to meet the recommendation (OR=2.28; 95% CI, 1.82-2.87). Obese individuals achieved it less frequently (OR=0.49; 95% CI, 0.40-0.61) than normal-weight individuals. Those whose job involved low-intensity physical activity achieved it more frequently than those with sedentary occupations (OR=1.21; 95% CI, 1.10-1.34). CONCLUSIONS The majority of adults in Madrid did not achieve the recommended LTPA level. Adherence was lower in women, older individuals, the less well-educated and the obese, while it was greater in those with a job involving low-intensity physical activity.

A sampling design for a Sentinel General Practitioner Network

OBJECTIVE To construct a design for probabilistic sampling of reporting physicians in sentinel networks. METHODS We performed a multi-stage sample selection study. Data on primary care physicians and their patients were obtained from the Madrid Health Institute for 2005. The geographical unit of reference was the basic health area. A factorial analysis was performed on the basis of demographic, socio-cultural and socio-occupational variables. A cluster analysis was conducted to group the 247 basic health areas into homogeneous strata, which were then tested using a discriminant analysis. The general practitioners and pediatricians needed in each stratum were selected by simple random sampling. The representativeness of the population monitored by the selected physicians was studied with respect to the population of Madrid. RESULTS Factorial analysis yielded five factors. Using these, 14 strata were obtained, which were shown to be homogeneous and mutually different by discriminant analysis. The minimum population that needed to be monitored consisted of 146,946 adults and 24,518 children, proportionally distributed among the respective strata. Eighty-eight general practitioners and 32 pediatricians were selected, who respectively covered populations of 154,610 and 31,336 persons representative of the general population. CONCLUSIONS Obtaining samples through suitable designs improves the accuracy of the information gathered by health sentinel networks in epidemiologic surveillance. Ensuring the representativeness of the study population vis-à-vis the general population is essential; cluster analysis and simple random sampling are methods that meet this need. Selecting physicians by means of probabilistic methods enables the accuracy of estimates to be ascertained.

Agregación de factores de riesgo ligados al comportamiento y su relación con la salud subjetiva

Objectives: To describe the clustering of behavior-related risk factors in the adult population of the Autonomous Community of Madrid (Spain) and evaluate the association between the level of aggregation of these factors and suboptimal subjective health. Methods: Data were drawn from the Non-communicable Disease Risk-Factor Surveillance System (Sistema de Vigilancia de Factores de Riesgo asociados a Enfermedades No Transmisibles [SIVFRENT]). We studied the associations between smoking, high-risk alcohol consumption, leisure-time sedentariness and unbalanced diet in 16,043 persons aged 1864 years and compared the observed against the expected proportions. Logistic regression was used to estimate the association between clustering of risk factors and suboptimal health (fair, poor and very poor). Results: Almost 20% of subjects had 3 or 4 risk factors simultaneously. Most combinations of 3 risk factors exceeded expectations and, in particular, 4 factor clustering yielded observed/expected quotients of 2.15 (95% confidence interval [CI]: 1.93-2.38) in men and 2.96 (95% CI, 2.46-3.46) in women. In both sexes, the individual factor most closely associated with the remaining risk factors was smoking. Aggregation of risk factors was more frequent among men, younger age groups and subjects with low educational level. Compared with persons with none of the 4 risk factors, those that simultaneously had 3 or 4 more frequently reported suboptimal subjective health (OR = 2.49; 95% CI, 1.59-3.90 in men and OR = 1.96; 95% CI, 1.29-2.97 in women). Conclusions: Behavior-related risk factors tend to aggregate, and this accumulation is higher among men, younger age groups, and subjects with a low educational level. A greater level of clustering is associated with a higher frequency of suboptimal perceived health.