Izabella Rohlfs

Estimación del riesgo coronario en España mediante la ecuación de Framingham calibrada

Rev Esp Cardiol 2003;56(3):253-61 253 Introducción y objetivos. Las ecuaciones de Framingham sobrestiman el riesgo de enfermedad coronaria en los países cuya incidencia es baja. En éstos, la ecuación debería adaptarse para la correcta prevención de la enfermedad coronaria. Se presentan las tablas de riesgo coronario global de Framingham calibradas para la población española. Pacientes y método. Se utilizó el procedimiento de calibración de la ecuación de Framingham, consistente en sustituir la prevalencia de factores de riesgo cardiovascular y la tasa de incidencia de acontecimientos coronarios de Framingham por las de nuestro medio. Se ha usado la ecuación de Framingham, que incluye el colesterol unido a lipoproteínas de alta densidad (cHDL). Se han calculado las probabilidades de acontecimiento a los 10 años y se han elaborado unas tablas con códigos de color y la probabilidad exacta en cada casilla correspondiente a las distintas combinaciones de los factores de riesgo clásicos, para una concentración de cHDL de 35-59 mg/dl. Resultados. Las tasas de acontecimientos coronarios y la prevalencia de factores de riesgo difieren considerablemente entre la población estudiada y Framingham. Valores de cHDL < 35 mg/dl incrementan el riesgo en un 50% y los > 60 mg/dl lo reducen en un 50%, aproximadamente. La proporción de casillas con una probabilidad de acontecimiento coronario a los 10 años superior al 9% es 2,3 veces menor, y la de casillas con una probabilidad > 19% es 13 veces menor en las tablas calibradas que en las originales de Framingham. Conclusiones. La función de Framingham calibrada puede constituir un instrumento para estimar con más precisión el riesgo coronario global en la prevención primaria de esta enfermedad en España. Su uso debe acompañarse de una validación apropiada y se debe trabajar en la elaboración de ecuaciones propias españolas.

Comparación de la función de Framingham original y la calibrada del REGICOR en la predicción del riesgo coronario poblacional

Fundamento y objetivo: Se desconocen las implicaciones terapeuticas derivadas del uso de la funcion de riesgo coronario de Framingham calibrada por los investigadores de los estudios REGICOR y Framingham (Framingham-REGICOR) para la poblacion espanola. El objetivo de este estudio fue determinar las diferencias en la clasificacion del riesgo de la poblacion de 35 a 74 anos usando la funcion de Framingham clasica (Framingham-Wilson) y la calibrada y sus consecuencias en la indicacion de tratamiento hipolipemiante con las guias de practica clinica. Pacientes y metodo: Se comparo la clasificacion en las categorias de riesgo a 10 anos de = 40% observada mediante ambas funciones en 3.270 individuos de entre 35 y 74 anos sin antecedentes de cardiopatia isquemica ni tratamiento hipolipemiante, provenientes de 2 muestras poblacionales representativas de la provincia de Girona, reclutadas entre 1994 y 2001. Se calculo el numero de candidatos a tratamiento hipolipemiante segun las guias vigentes de practica clinica y las 2 funciones. Resultados: Un 5,9% del total de la muestra recibia tratamiento hipolipemiante en el momento del examen. La funcion Framingham-REGICOR asigno al 54,2% de las mujeres y al 67,9% de los varones no diabeticos a una categoria de riesgo inferior que la funcion Framingham-Wilson. El 0,2% de las mujeres y el 21,2% de los varones descendieron dos categorias. Un 75,7% de los participantes diabeticos descendio una categoria y el 18,5% descendio dos. Con las guias europeas de 2003 recibirian hipolipemiantes el 14,5 y el 4,4% de participantes no diabeticos usando las funciones de Framingham-Wilson y Framingham-REGICOR, respectivamente. Conclusiones: La funcion calibrada de Framingham-REGICOR adjudica una categoria de riesgo coronario menor que la de Framingham original en mas del 50% de mujeres y casi el 90% de varones. Es una herramienta mas recomendable que esta en la prevencion primaria de la enfermedad coronaria en Espana.

Prevalencia de diabetes mellitus en la provincia de Girona, España: el estudio REGICOR

El objetivo fue determinar la prevalencia de diabetes mellitus en la poblacion de 25 a 74 anos de la provincia de Girona. Se obtuvieron los antecedentes personales de diabetes mellitus conocida y la glucemia en ayunas en sangre venosa. Se aplicaron los criterios diagnosticos de la American Diabetes Association de 1997. La prevalencia cruda de antecedentes de diabetes mellitus fue del 10% y la estandarizada por edad del 7,7% (intervalo de confianza [IC] del 95%, 7,3-8,1). La prevalencia cruda de glucosa alterada en ayunas fue del 8,6% y la estandarizada por edad del 7,6% (IC del 95%, 7,2-8,1). La prevalencia cruda de antecedentes de diabetes mellitus conocida mas la definida por glucemia (prevalencia total de diabetes mellitus) fue del 13% y la estandarizada del 10% (IC del 95%, 9,6-10,5). Se observo una mayor prevalencia en varones y un aumento con la edad. Estas cifras difieren de las obtenidas en algunos estudios realizados en Espana.

Social inequalities in health related behaviours in Barcelona

OBJECTIVE This study describes social class inequalities in health related behaviours (tobacco and alcohol consumption, physical activity) among a sample of general population over 14 years old in Barcelona. DESIGN Cross sectional study (Barcelona Health Interview Survey). SETTING Barcelona city (Spain). PARTICIPANTS A representative stratified sample of the non-institutionalised population resident in Barcelona was obtained. This study refers to the 4171 respondents aged over 14. DATA Social class was obtained from a Spanish adaptation of the British Registrar General classification. In addition, sociodemographic variables such as family structure and employment status were used. As health related behaviours tobacco consumption, alcohol consumption, usual physical activity and leisure time physical activity were analysed. Age adjusted percentages were compared by social class. Multivariate analysis was performed using logistic regression models. MAIN RESULTS Women in the upper social classes were more likely to smoke, the adjusted odds ratio (OR) for social class V in reference to social class I was 0.36 (95% confidence intervals (95%CI): 0.19, 0.67), while the opposite occurred among men although it was not statistically significant in multivariate analysis. Smoking cessation was more likely among men in the higher classes (OR for class V 0.41, 95%CI: 0.18, 0.90). Excessive alcohol consumption among men showed no differences between classes, while among women it was greater in the upper classes. Engaging in usual physical activity classified as “light or none” in men decreased with lowering social class (OR class IVa: 0.55 and OR class IVb: 0.47). Women of social classes IV and V were less likely to have two or more health risk behaviours (OR for class V 0.33, 95% CI: 0.18, 0.62). CONCLUSION Health damaging behaviours are differentially distributed among social classes in Barcelona. Health policies should take into account these inequalities.

Perceived discrimination and health by gender, social class, and country of birth in a Southern European country.

OBJECTIVES.: This study aimed to examine the association between perceived discrimination and five health outcomes in Spain as well as to analyze whether these relationships are modified by sex, country of birth, or social class. METHODS.: We used a cross-sectional design. Data were collected as part of the 2006 Spanish Health Interview Survey. The present analysis was restricted to the population aged 16-64 years (n=23,760). Five dependent variables on health obtained through the questionnaire were examined. Perceived discrimination was the main independent variable. We obtained the prevalence of perceived discrimination. Logistic regression models were fitted. RESULTS.: Perceived discrimination was higher among populations originating from low income countries and among women and showed positive and consistent associations with all poor health outcomes among men and with 3 poor health outcomes among women. Poor mental health showed the largest difference between people who felt and those who did not feel discriminated (prevalence for these 2 groups among men was 42.0% and 13.3%, and among women, was 44.7% and 22.8%). The patterns found were modified by gender, country of birth, and social class. CONCLUSION.: This study has found a consistent relationship of discrimination with five health indicators in Spain, a high-income Southern European country. Public policies are needed that aim to reduce discrimination.

Perfil sociodemográfico de las mujeres afectadas por violencia del compañero íntimo en España

OBJECTIVE To determine the prevalence of reported intimate partner violence (IPV) and to analyze the main sociodemographic characteristics of affected women. METHODS We performed a cross-sectional study based on the Spanish National Health Survey of 2006. The sample comprised 13,094 women who agreed to answer questions about violence (87.2% of the total interviewees). Bivariate and multivariate analyses were performed. The dependent variable was reported IPV and the independent variables were educational level, employment, marital status, living arrangements with the partner or analogous individual, number of children at home, nationality (Spanish vs. foreign women) and age. RESULTS IPV was reported by 1% (n=128) of the sample. Women with primary school education or without studies (odds ratio [OR]: 3.63 [1.90-6.92]), with three or more children (OR: 3.51 [1.78-6.90]), and those who were separated or divorced (OR: 2.81 [1.89-4.97]) were most likely to experience IPV when the effect of the remaining variables was controlled. The likelihood of IPV was also higher in women born outside Spain (OR: 2.83 [1.87-4.28]). CONCLUSIONS IPV seems not to affect Spanish and foreign women equally. The characteristics most closely associated with women affected by IPV were educational level, the number of children at home and marital status. The sensitivity of current measures against IPV should be considered in relation to the needs of affected women.

Social Inequalities in Perceived Health and the Use of Health Services in a Southern European Urban Area

People of lower social class have worse health and less access to health services and preventive care. This article describes social class inequalities in health status and use of services, both curative and preventive, in Barcelona, in a country with a national health service. The cross-sectional study uses information from the 1992 Barcelona Health Interview Survey. Social class was designated using an adaptation of the British Registrar General classification. The study variables measured health status, health services utilization, and preventive practices. Bivariate and multivariate analyses were used. Some 88 percent of men in social class I and 81 percent in class V had very good or good perceived health status. For women these figures were 85.2 and 57.6 percent, respectively. Chronic illness increased with lower social class. There were no social class differences in the frequency of physician visits during the two weeks prior to the interview among people with poor perceived health. Some 60.7 percent of women aged over 29 in social class I had periodic cervical smears, but only 32 percent of those in class V; the corresponding figures for mammography were 37.8 and 11.3 percent. The national health service has advantages in terms of access to health services, but more knowledge about the quality of these services is required. The study findings are sufficient to defend the undertaking of equitable health policies, especially in providing access to preventive care for the entire population.

Comparison between telephone and self-administration of Short Form Health Survey Questionnaire (SF-36)

OBJECTIVE The characteristics of the 36 item Medical Outcome Short Form Health Study Survey (SF-36) questionnaire, designed as a generic indicator of health status for the general population, allow it to be self-administered or used in personal or telephone interviews. The main objective of the study was to compare the telephone and self-administered modes of SF-36 for a population from Girona (Spain). METHODS A randomized crossover administration of the questionnaire design was used in a cardiovascular risk factor survey. Of 385 people invited to participate in the survey, 351 agreed to do so and were randomly assigned to two orders of administration (i.e., telephone-self and self-telephone); 261 completed both questionnaires. Scores were compared between administration modes using a paired t test. Internal consistency and agreement between modalities were analyzed by respectively applying Chronbachs alpha and intraclass correlation coefficients. The effect of the order of administration on the test-retest difference was analyzed by one-way ANOVA for repeated measurements. RESULTS Physical function, physical role and social functioning received significantly lower scores when the self-administered questionnaire was used prior to the telephone survey. When the initial survey was conducted by telephone, all Chronbachs alpha coefficients (except social functioning) scored over 0.70 in the self-administered modality. The intraclass correlation coefficient ranged from 0.41 to 0.83 for the telephone-self order and from 0.32 to 0.73 for the self-telephone order. No clinically significant effect was observed for the order of application. CONCLUSIONS The results of the present study suggest that the telephone-administration mode of SF-36 is equivalent to and as valid as the self-administered mode.

Perceived Sexism as a Health Determinant in Spain

OBJECTIVES The goals of the present study are to explore the association between perceived sexism and self-perceived health, health-related behaviors, and unmet medical care needs among women in Spain; to analyze whether higher levels of discrimination are associated with higher prevalence of poor health indicators and to examine whether these relationships are modified by country of origin and social class. MATERIALS AND METHODS The study is based on a cross-sectional design using data from the 2006 Spanish Health Interview Survey. We included women aged 20-64 years (n = 10,927). Six dependent variables were examined: four of health (self-perceived health, mental health, hypertension, and having had an injury during the previous year), one health behavior (smoking), and another related to the use of the health services (unmet need for medical care). Perceived sexism was the main independent variable. Social class and country of origin were considered as effect modifiers. We obtained the prevalence of perceived sexism. Logistic regression models, adjusted for potential confounders, were fitted to study the association between sexism and poor health outcomes. RESULTS The prevalence of perceived sexism was 3.4%. Perceived sexism showed positive and consistent associations with four poor health outcomes (poor self-perceived health, poor mental health, injuries in the last 12 months, and smoking). The strength of these associations increased with increased scores for perceived sexism, and the patterns were found to be modified by country of origin and social class. CONCLUSION This study shows a consistent association between perceived sexism and poor health outcomes in a country of southern Europe with a strong patriarchal tradition.

Posición socioeconómica e infarto agudo de miocardio. Estudio caso-control de base poblacional

Introduccion y objetivos. La posicion socioeconomica se relaciona con la mortalidad cardiovascular. El objetivo de este estudio fue analizar la relacion entre la posicion socioeconomica y sus diferentes indicadores y el riesgo de infarto agudo de miocardio (IAM), y determinar si esta era independiente de los factores de riesgo cardiovascular (FRCV). Metodos. Estudio caso-control apareado por edad, sexo y ano de reclutamiento. Los casos se obtuvieron de un registro hospitalario y los controles, de estudios transversales de base poblacional. La posicion socioeconomica se determino por el nivel de estudios y la clase social basada en ocupacion. Se recogio informacion autodeclarada sobre los FRCV. Resultados. Se incluyo a 1.369 casos y controles. Hubo interaccion entre nivel de estudios y clase social: en los trabajadores no manuales el nivel de estudios se asocio de forma lineal, inversa e independiente de los FRCV con el riesgo de IAM (estudios secundarios, odds ratio [OR] = 1,63; intervalo de confianza [IC] del 95%, 1,16-2,3; estudios primarios, OR = 3,88; IC del 95%, 2,79-5,39) respecto a universitarios; en los trabajadores manuales no se observo una asociacion entre nivel de estudios y riesgo de IAM. Los trabajadores manuales presentaban un exceso de riesgo de IAM respecto a los no manuales universitarios, este exceso de riesgo era independiente de los FRCV en el grupo con estudios primarios (OR = 2,09; IC del 95%, 1,59-2,75). Conclusiones. Hay relacion entre la posicion socioeconomica y el riesgo de IAM. El grupo de la poblacion con nivel de estudios primarios presenta mayor riesgo de IAM que es independiente de los FRCV y de la clase social basada en la ocupacion