Janko Janković

Risk factors for psoriasis: A case–control study

A case–control study of 110 consecutive psoriatic outpatients and 200 unmatched controls was carried out in order to analyze the association of psoriasis with smoking habits, alcohol consumption, family history of psoriasis and stressful life events. Stressful life events were assessed with Paykels Interview for Recent Life Events, a semi‐structured interview covering 63 life events. According to our results, the risk of psoriasis is higher in urban dwellers (odds ratio [OR] = 3.61; 95% confidence interval [CI] = 0.99–13.18), patients who were divorced (OR = 5.69; 95% CI = 2.26–14.34) and those exposed to environmental tobacco smoke at home (OR = 2.29; 95% CI = 1.12–4.67). Alcohol consumption (OR = 2.55; 95% CI = 1.26–5.17), family history of psoriasis (OR = 33.96; 95% CI = 14.14–81.57) and change in work conditions (OR = 8.34; 95% CI = 1.86–37.43) are also risk factors for psoriasis. Separate analyses for men and women showed that the risk of developing psoriasis was stronger in men with a family history of psoriasis (OR = 30.39; 95% CI = 6.72–137.42) than in women (OR = 16.99; 95% CI = 7.21–40.07). The effect of environmental tobacco smoke at home was found only in women (OR = 2.44; 95% CI = 1.26–4.73). Future well‐designed epidemiological studies need to be performed in order to determine whether lifestyle factors and stress could be risk factors triggering or aggravating psoriasis.

Inequalities that hurt: demographic, socio-economic and health status inequalities in the utilization of health services in Serbia

BACKGROUND The aim of this study was to analyse demographic, socio-economic and health status inequalities by gender in the utilization of health services in Serbia. METHODS Data from 2006 National Health Survey for Serbia were used. A total of 14,522 persons from six geographical regions of Serbia aged >or=20 years were completely interviewed. Logistic regression analyses were used to study the effects of demographic (age, gender, marital status and type of settlement), socio-economic (education and Wealth Index) and health status (self-perceived health) variables on the utilization of health services [visits to general practitioner (GP), private doctor, dentist and hospitalization]. All analyses were carried out separately for males and females. RESULTS As compared with women (reference category), a lower percentage of men visited a GP [odds ratio (OR) = 0.61; 95% confidence interval (95% CI) = 0.57-0.65], private doctor (OR = 0.62; 95% CI = 0.57-0.67) and dentist (OR = 0.81; 95% CI = 0.76-0.87), but there were no gender differences in hospitalization. Both males and females who belong to disadvantaged classes were less likely to have visited a GP, a private doctor or a dentist in 12 months before the interview, regardless of their health status. No inequalities by social class were observed for the hospitalization among persons with poor self-perceived health status, i.e. those in most need. CONCLUSIONS This study has shown that demographic, socio-economic and health status inequalities in the utilization of health services exist in Serbia. Wise health policy with equitable utilization of health services, regardless these inequalities should be a priority in shaping Serbian health care system reform.

Association of socioeconomic status measured by education, and cardiovascular health: a population-based cross-sectional study

Objective Cardiovascular health (CVH) is a relatively new concept defined by the American Heart Association (AHA). The aim of the present study was to assess whether the indices of CVH were discriminators of socioeconomic status (SES) in the adult population of the Republic of Srpska (RS). Design Population-based cross-sectional study. Setting RS, Bosnia and Herzegovina. Participants The study involved 4165 adults aged ≥18 years (mean age 50.2; 54% women) who participated in the National Health Survey performed from September to November 2010 in the RS. Study variables Participants education was a proxy for SES. Potential discriminators of SES were indices of CVH presented according to AHA as: ideal health behaviours index (non-smoking, body mass index <25 kg/m2, physical activity at goal level and healthy diet); ideal health factors index (untreated total cholesterol <200 mg/dL, untreated blood pressure <120/<80 mm Hg, untreated fasting glucose <100 mg/dL and non-smoking); and ideal CVH status (defined as all seven ideal health metrics present) versus intermediate and poor CVH status. Results Participants with high educational levels had a significantly greater number of ideal CVH metrics, and ideal health factor metrics compared with those with low or medium educational level (OR 0.88 95% CI 0.77 to 0.99 and OR 0.88 95% CI 0.80 to 0.96; OR 0.81 95% CI 0.69 to 0.96 and OR 0.77 95% CI 0.68 to 0.87; respectively). The number of ideal behaviour metrics was not a discriminator of educational groups. Concerning the categories of CVH status the poor CVH was a discriminator for low and medium education compared with those with high education (OR 1.93 95% CI 1.24 to 3.01 and OR 1.54 95% CI 1.08 to 2.19, respectively). Conclusions Our findings emphasise the large potential for preventing cardiovascular disease, showing a low proportion with a favourable CVH profile, especially among low-educated people. It is necessary to consider prevention strategies aimed at improving CVH in RS, targeting primarily low educational groups.

Time trends in Balkan endemic nephropathy incidence in the most affected region in Serbia, 1977–2009: the disease has not yet disappeared

BACKGROUND Balkan endemic nephropathy (BEN) is a familial chronic kidney disease, which occurs only in some regions of the Balkan Peninsula. The aim of this study was to determine the main epidemiological features of BEN in the Kolubara region, the most affected region in Serbia, and to try to elucidate the controversial issue of whether or not BEN is tapering off. METHODS To evaluate the BEN incidence rates in the municipality of Lazarevac over a 33-year period (1977-2009), we used data of BEN notifications from the BEN Registry located in the Special Hospital for Endemic Nephropathy, Lazarevac. Population data were obtained from the 1981, 1991 and 2002 national censuses by interpolation. BEN incidence rates were standardized according to the European standard population, and their trends were assessed by Poisson regression model and joinpoint analysis. RESULTS The age-adjusted BEN incidence rates combined for both sexes over a 33-year period (1977-2009) fitted a significant quadratic (U-shaped) trend (y = 58.44 - 3.76 + 0.10x(2), P = 0.026). Joinpoint analysis showed that the overall age-standardized BEN incidence rates significantly decreased in the first decade of the observed period (1977-89) by an average of 10.0% annually, while a nonsignificant increase of 3.9% per year was recorded in the last two decades (1989-2009). CONCLUSIONS Our results revealed that BEN still exists in the Kolubara region. The predicted disappearing scenario of this still mysterious disease has not happened.

Socioeconomic inequalities, health damaging behavior, and self-perceived health in Serbia: a cross-sectional study.

Aim To analyze the association of socioeconomic factors with self-perceived health in Serbia and examine whether this association can be partly explained by health behavior variables. Methods We used data from the 2007 Living Standards Measurement Study for Serbia. A representative sample of 13 831 persons aged ≥20 years was interviewed. The associations between demographic factors (age, sex, marital status, and type of settlement), socioeconomic factors (education, employment status, and household consumption tertiles), and health behavior variables (smoking, alcohol consumption) and self-perceived health were examined using logistic regression analyses. Results A stepwise gradient was found between education and self-perceived health for the total sample, men, and women. Compared to people with high education, people with low education had a 4.5 times higher chance of assessing their health as poor. Unemployed (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.29-2.10), inactive (OR, 2.82; 95% CI, 2.49-3.19), and the most deprived respondents (OR, 1.17; 95% CI, 1.02-1.34) were more likely to report poor self-perceived health than employed persons and the most affluent group. After adjustment for demographic and health behavior variables, the magnitudes of all associations decreased but remained clearly and significantly graded. Conclusions This study revealed inequalities in self-perceived health by socioeconomic position, in particular educational and employment status. The reduction of such inequalities through wisely tailored interventions that benefit people’s health should be a target of a national health policy in Serbia.

Socio-Economic Differences in Cardiovascular Health: Findings from a Cross-Sectional Study in a Middle-Income Country

Background A relatively consistent body of literature, mainly from high-income countries, supports an inverse association between socio-economic status (SES) and risk of cardiovascular disease (CVD). Data from low- and middle-income countries are scarce. This study explores SES differences in cardiovascular health (CVH) in the Republic of Srpska (RS), Bosnia and Herzegovina, a middle-income country. Methods We collected information on SES (education, employment status and household’s relative economic status, i.e. household wealth) and the 7 ideal CVH components (smoking status, body mass index, physical activity, diet, blood pressure, total cholesterol, and fasting blood glucose) among 3601 participants 25 years of age and older, from the 2010 National Health Survey in the RS. Based on the sum of all 7 CVH components an overall CVH score (CVHS) was calculated ranging from 0 (all CVH components at poor levels) to 14 (all CVH components at ideal levels). To assess the differences between groups the chi-square test, t-test and ANOVA were used where appropriate. The association between SES and CVHS was analysed with multivariate linear regression analyses. The dependent variable was CVHS, while independent variables were educational level, employment status and wealth index. Results According to multiple linear regression analysis CVHS was independently associated with education attainment and employment status. Participants with higher educational attainment and those economically active had higher CVHS (b = 0.57; CI = 0.29–0.85 and b = 0.27; CI = 0.10–0.44 respectively) after adjustment for sex, age group, type of settlement, and marital status. We failed to find any statistically significant difference between the wealth index and CVHS. Conclusion This study presents the novel information, since CVHS generated from the individual CVH components was not compared by socio-economic status till now. Our finding that the higher overall CVHS was independently associated with a higher education attainment and those economically active supports the importance of reducing socio-economic inequalities in CVH in RS.

Sex inequalities in cardiovascular health: a cross-sectional study.

BACKGROUND The aim of this study was to determine sex differences in the prevalence of cardiovascular health (CVH) metrics according to the CVH status. METHODS The cross-sectional, population-based study involved 2250 women and 1920 men aged ≥18 years that participated in the 2010 National Health Survey in the Republic of Srpska, Bosnia and Herzegovina. Prevalence of CVH behaviours (smoking, body mass index, physical activity, diet), CVH factors (cholesterol, fasting blood glucose and blood pressure, plus smoking) and ideal CVH were estimated according to the American Heart Association criteria for ideal, intermediate and poor levels. Association between sex and ideal CVH categories was analyzed with multivariable logistic regression analysis across three age stratums. RESULTS A higher prevalence of ideal CVH metrics was seen in women for smoking status, body mass index, healthy diet score and blood pressure, and in men for physical activity and total cholesterol. Women from all age groups had better CVH behaviours (odds ratio [OR] = 1.40 for the youngest; OR = 2.05 for middle-aged; and OR = 2.03 for older-aged women), while only women from the youngest age group had better CVH factors (OR = 5.09). In line with this, ideal overall CVH prevailed in younger and middle-aged women in comparison to men of the same ages (OR = 3.01 and OR = 2.25, respectively), while disappeared in older ones. CONCLUSIONS Significant differences in the prevalence of CVH metrics between men and women in the Republic of Srpska should be considered in cardiovascular disease prevention.

Utility of data from a national health survey: do socioeconomic inequalities in morbidity exist in Serbia?

Aims: The aim of this study was to analyse the impact of demographic and socioeconomic factors on morbidity in Serbia. Additionally, knowing that there is no a gold standard for measuring morbidity we were concerned whether the results of this study depend on the choice of morbidity indicator. Methods: Data from the 2006 National Health Survey for Serbia were used. A representative sample of 14,522 persons aged ≥20 years were interviewed. The associations between demographic factors (age, gender, marital status, and type of settlement), socioeconomic indicators (education and wealth index), and health status (morbidity index derived from self-reported data) were examined using linear and logistic regression analyses. Results: Women, elderly people, those who live in urban settings, and those with lower education had higher morbidity regardless of using a morbidity index as a continuous variable (composite index ranging from 0 to 20) or a categorical variable (morbidity status tertiles). Respondents who belong to the most deprived group had higher scores of morbidity index in comparison with the respondents from the most affluent group, but no significant association was found when morbidity status was examined as the outcome. In addition, when those who belong to the middle class group were compared to the most affluent group, they had good more frequently than average morbidity status. Conclusions: This study suggests that demographic and socioeconomic inequalities in morbidity exist in Serbia. Wise and comprehensive health policies and interventions for reducing these inequalities are urgently needed which primarily focus on the most disadvantaged socioeconomic groups.

Prevalence of metabolic syndrome in patients with psoriasis: a hospital-based cross-sectional study

BACKGROUND Emerging epidemiological evidence suggests independent associations between psoriasis and metabolic syndrome. Objectives: The aim of the study was to examine the prevalence of metabolic syndrome and its components in patients with psoriasis, and to assess which factors may predict metabolic syndrome in these patients. METHODS A hospital-based, cross-sectional study with 244 psoriatic patients and 163 control subjects with skin diseases other than psoriasis was conducted at the Clinic of Dermatovenerology, Clinical Center of Serbia, Belgrade, from October 2011 to October 2012. Metabolic syndrome was defined using the revised National Cholesterol Education Program Adult Treatment Panel III. Severity of psoriasis was measured by Psoriasis Area and Severity Index and Body Surface Area. RESULTS The adjusted odds ratios (ORs) and 95% confidence intervals (CI) for psoriasis patients vs. non-psoriasis patients were 2.66 (95% CI, 1.58-4.42) for metabolic syndrome, 3.81 (95% CI, 2.30-6.31) for hypertension, 2.29 (95% CI, 1.39-3.78) for central obesity, 1.92 (95% CI, 1.08-3.41) for hyperglycemia, 1.87 (95% CI 1.18-2.96) for low high-density lipoprotein cholesterol level, and 1.42 (95% CI, 0.87-1.04) for hypertrigliceridemia. We failed to find any statistically significant association between the metabolic syndrome and clinical severity of psoriasis. Later onset and longer duration of psoriasis were predicting factors for metabolic syndrome in our patients. Study limitations: The cross-sectional design of the study does not allow us to draw directional causal inferences concerning the association between psoriasis and metabolic syndrome. Factors such as diet, alcohol consumption or mental health, which have not been evaluated in this study, may be confounders in this relation. CONCLUSION A higher prevalence of metabolic syndrome and its components in patients with psoriasis than in controls, regardless of disease severity, emphasizes the need for early treatment and follow-up of all psoriatic patients with respect to metabolic diseases.

Quality of life in patients with alopecia areata: a hospital‐based cross‐sectional study

Previous studies suggest that alopecia areata (AA) may significantly affect patient quality of life (QoL). There are no studies that assess QoL in Serbian AA patients.