Jonatan Konfino

Impact on cardiovascular disease events of the implementation of Argentina's national tobacco control law

Background Argentinas congress passed a tobacco control law that would enforce 100% smoke-free environments for the entire country, strong and pictorial health warnings on tobacco products and a comprehensive advertising ban. However, the Executive Branch continues to review the law and it has not been fully implemented. Our objective was to project the potential impact of full implementation of this tobacco control legislation on cardiovascular disease. Methods The Coronary Heart Disease (CHD) Policy Model was used to project future cardiovascular events. Data sources for the model included vital statistics, morbidity and mortality data, and tobacco use estimates from the National Risk Factor Survey. Estimated effectiveness of interventions was based on a literature review. Results were expressed as life-years, myocardial infarctions and strokes saved in an 8-year-period between 2012 and 2020. In addition we projected the incremental effectiveness on the same outcomes of a tobacco price increase not included in the law. Results In the period 2012–2020, 7500 CHD deaths, 16 900 myocardial infarctions and 4300 strokes could be avoided with the full implementation and enforcement of this law. Annual per cent reduction would be 3% for CHD deaths, 3% for myocardial infarctions and 1% for stroke. If a tobacco price increase is implemented the projected avoided CHD deaths, myocardial infarctions and strokes would be 15 500, 34 600 and 11 900, respectively. Conclusions Implementation of the tobacco control law would produce significant public health benefits in Argentina. Strong advocacy is needed at national and international levels to get this law implemented throughout Argentina.

Relación costo-utilidad de la disminución del consumo de sal y su efecto en la incidencia de enfermedades cardiovasculares en Argentina

OBJETIVO: Estimar la relacion costo-utilidad de una intervencion dirigida a reducir el consumo de sal en la dieta de personas mayores de 35 anos en Argentina. METODOS: La intervencion consistio en reducir entre 5% y 25% el contenido de sal en los alimentos. Se utilizo el modelo de simulacion del impacto de las politicas sobre la enfermedad coronaria para predecir la evolucion de la incidencia, la prevalencia, la mortalidad y los costos en la poblacion de la enfermedad coronaria y cerebrovascular en personas de 35 a 84 anos. Se modelo el efecto y los costos de una disminucion de 3 g de sal en la dieta, mediante su reduccion en alimentos procesados y en la anadida por los consumidores, por un periodo de 10 anos. Se estimo el cambio en la ocurrencia de eventos en este periodo y la ganancia en anos de vida ajustados por la calidad (AVAC) en un escenario de efecto alto y otro de efecto bajo. RESULTADOS: La intervencion genero un ahorro neto de US

Projected Impact of a Sodium Consumption Reduction Initiative in Argentina: An Analysis from the CVD Policy Model – Argentina

3 765 millones y una ganancia de 656 657 AVAC en el escenario de efecto alto y de US

Barriers to prevention of cardiovascular disease in primary care settings in Argentina

2 080 millones y 401 659 AVAC en el escenario de efecto bajo. Se obtendrian reducciones en la incidencia de enfermedad coronaria (24,1%), infarto agudo de miocardio (21,6%) y accidente cerebrovascular (20,5%), y en la mortalidad por enfermedad coronaria (19,9%) y por todas las causas (6,4%). Se observaron beneficios para todos los grupos de edad y sexo. CONCLUSIONES: La implementacion de esta estrategia de reduccion del consumo de sal produciria un efecto sanitario muy positivo, tanto en AVAC ganados como en recursos economicos ahorrados.

Sex-stratified and age-adjusted social gradients in tobacco in Argentina and Uruguay: evidence from the Global Adult Tobacco Survey (GATS)

Background Cardiovascular disease (CVD) is the leading cause of death in adults in Argentina. Sodium reduction policies targeting processed foods were implemented in 2011 in Argentina, but the impact has not been evaluated. The aims of this study are to use Argentina-specific data on sodium excretion and project the impact of Argentina’s sodium reduction policies under two scenarios - the 2-year intervention currently being undertaken or a more persistent 10 year sodium reduction strategy. Methods We used Argentina-specific data on sodium excretion by sex and projected the impact of the current strategy on sodium consumption and blood pressure decrease. We assessed the projected impact of sodium reduction policies on CVD using the Cardiovascular Disease (CVD) Policy Model, adapted to Argentina, modeling two alternative policy scenarios over the next decade. Results Our study finds that the initiative to reduce sodium consumption currently in place in Argentina will have substantial impact on CVD over the next 10 years. Under the current proposed policy of 2-year sodium reduction, the mean sodium consumption is projected to decrease by 319–387 mg/day. This decrease is expected to translate into an absolute reduction of systolic blood pressure from 0.93 mmHg to 1.81 mmHg. This would avert about 19,000 all-cause mortality, 13,000 total myocardial infarctions, and 10,000 total strokes over the next decade. A more persistent sodium reduction strategy would yield even greater CVD benefits. Conclusion The impact of the Argentinean initiative would be effective in substantially reducing mortality and morbidity from CVD. This paper provides evidence-based support to continue implementing strategies to reduce sodium consumption at a population level.

Exposición a la publicidad del tabaco en los puntos de venta en Argentina. Evidencias de la Encuesta Nacional de Factores de Riesgo 2013

OBJECTIVE To identify main barriers to preventing cardiovascular disease and implementing clinical practice guidelines in primary care, to pilot implementation of a tailored enactment of the adapted World Health Organization guidelines to prevent cardiovascular disease, and to assess the impact of the intervention in risk stratification. METHODS A qualitative study was done with decision makers, health professionals, and staff from five primary health care centers, who were interviewed to identify the main barriers. A tailored intervention to apply the guidelines was then designed and implemented. To assess the impact of the intervention on risk factor screening, a before-and-after analysis was performed through a records review of independent samples of patients aged 40 years or older attending each center. RESULTS The main barriers identified were lack of awareness of guidelines and lack of knowledge about preventing cardiovascular disease, communication problems within health teams, lack of motivation, and organizational problems. Before (n = 226) and after (n = 234) the intervention, screening of the main risk factors increased: blood pressure measurement from 44.3% to 72.6%, cholesterol measurement from 20.7% to 49.7%, smoking status assessment from 20.4% to 56.1%, diabetes status assessment from 25.5% to 93.6%, and previous vascular event status from 33.2% to 74.3%. Global risk stratification was not done at baseline, compared with 45.1% after the intervention. CONCLUSIONS The main barriers identified were useful in designing a tailored intervention. Although no clinical outcomes were evaluated, this study shows that the implementation is feasible, with increased risk stratification as a first step at better patient management.

Sex-stratified socio-economic gradients in physical inactivity, obesity, and diabetes: evidence of short-term changes in Argentina

Objective To examine social gradients in tobacco use in Argentina and Uruguay, using newly available directly comparable data sets. Methods Secondary analysis of Global Adult Tobacco Survey data from Argentina (N=6645) and Uruguay (N=5581). Social gradients in current tobacco use, exposure to secondhand smoke, and cessation attempt were examined with sex-stratified and age-adjusted logistic regression. Results Among men, there is evidence of higher odds of being a current smoker among respondents with lower levels of education, but the association is only statistically significant for respondents with less than primary education in Uruguay (OR=2.15, 95% CI 1.22 to 3.77). Similarly, women with lower levels of education have higher odds of being a current smoker in Uruguay. The association between education and exposure to secondhand smoke is broadly similar for both sexes in both countries, with generally higher odds among groups with low education, though the relationship is only statistically significant among men in Uruguay (OR=1.77, 95% CI 1.08 to 2.92). In both countries, respondents with lower levels of education in general have higher odds of having attempted to quit smoking in the past year, although these associations did not attain statistical significance. Conclusions Social gradients in tobacco use, exposure to secondhand smoke and cessation attempts are broadly similar in both countries. Efforts to evaluate the long-term effects of tobacco control efforts in these countries should monitor how policies affect national averages, and the social gradients that are embedded in aggregate data.

Alfabetización en salud en pacientes que asisten a un hospital universitario

Resumen: Objetivo: Describir las caracteristicas de la poblacion que refiere haber acudido a los puntos de venta (PV) de tabaco en relacion con la percepcion de la publicidad en Argentina. Material y metodos: Se analizaron datos de la Encuesta Nacional de Factores de Riesgo de 2013. Resultados: Se incluyeron 31 167 encuestados que acudieron a comercios donde venden cigarrillos en los ultimos 30 dias. De estos, 54.1% dijo haber visto publicidad de cigarrillos. Los varones (RM=1.2) y los fumadores actuales (RM=1.9 vs. no fumador) tuvieron mas posibilidad de percibirla. Aquellos que refirieron estar expuestos al humo de tabaco en bares y restaurantes (RM= 1.2) tuvieron mas posibilidad de ver publicidad de tabaco en los puntos de venta. Hubo un gradiente en relacion con la edad: los jovenes de 18 a 24 fueron mas susceptibles a referir exposicion (RM=2.8 vs >65 anos). Entre los fumadores, aquellos que percibieron publicidad refirieron con mayor frecuencia haber intentado dejar de fumar en el ultimo ano. Conclusiones: Es importante que la regulacion de la publicidad en los PV sea mas estricta para limitar la exposicion a la publicidad, particularmente en los jovenes.