Enfermedades crónicas
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Item Niveles, tendencias e impacto de la mortalidad por cáncer de mama en Costa Rica según provincias, 2000–2009(Población y Salud en Mesoamérica, Volumen 9, número 1, artículo 4, julio-diciembre, 2011) Agudelo Botero, MarcelaEl objetivo planteado en este trabajo fue calcular y analizar los niveles, tendencias e impacto de la mortalidad por cáncer de mama en Costa Rica según provincias, para el periodo 2000–2009. Para tal propósito se utilizaron los registros de defunciones del Instituto Nacional de Estadística y Censos y otros datos (proyecciones la población femenina y tabla de vida de 2005), todos disponibles en el Centro Centroamericano de Población. Se calcularon las tasas brutas y estandarizadas de mortalidad y se estimaron los años de vida perdidos por cáncer de mama, todo ello a nivel nacional y provincial. Entre los hallazgos más importantes se tuvo que la tasa estandarizada de mortalidad por cáncer de mama aumentó 22% entre 2000 y 2009 a nivel nacional, pasando de 21.3 a 26.1 por cada cien mil mujeres. Para este último año, Heredia tuvo la tasa de mortalidad más alta del país y Cartago la más baja. En este periodo, tanto Cartago como Limón disminuyeron sus tasas de mortalidad por esta patología y el resto de provincias la aumentaron. En Costa Rica se perdieron 17 791 años vida por cáncer de mama en 2009, es decir que este indicador se incrementó moderadamente con respecto a 2000 donde alcanzó los 15 490. Los AVP en Costa Rica pueden ser explicados por fenómenos demográficos como cambios reproductivos de las mujeres y el envejecimiento poblacional, así como a aspectos relacionados con el acceso y calidad de los servicios de salud. The aim of this study was to determine and analyze the levels, trends and impact of breast cancer mortality in Costa Rica by provinces, for the period 2000 to 2009. For this purpose was used the death records of Instituto Nacional de Estadística y Censos and other data (the female population projections and life tables, 2005), all available on the Centro Centroamericano de Población. Was a calculated crude rate and standardized mortality and estimated life years lost from breast cancer, all national and provincial level. Among the most important findings was that the standardized mortality rate from breast cancer increased 22% between 2000 and 2009 throughout the county, going from 21.3 to 26.1 per hundred thousand women. For the last year, Heredia had the highest mortality rate in the country (even above the overall average) and the lowest Cartago. In this period, both Limon as Cartago lowered their rates of mortality for this disease and all other provinces increased it. In Costa Rica, years of life lost from breast cancer in 2009 was 17 791, this indicator increased moderately compared to 2000 which was 15 490. These AVP in Costa Rica can be explained by demographic phenomena as women's reproductive changes and aging population as well as issues related to access and quality of health services.Item Mortalidad por Diabetes tipo 2 en las fronteras de México(Población y Salud en Mesoamérica, Volumen 14, número 2 (enero-junio 2017), 2017) Manzanares Rivera, José LuisObjective: To analyze type II diabetes mortality rates geographic distribution and evolution in time across both Mexican border regions during the period 1998-2013. Methods: The work is based on exploratory and inferential data analysis conducted using death reprts from the national health information system. The analys is considers social determinants of health as a theoretical paradigm and includes microdata on consumption patterns at household level for the US -Mexico and Mexico- Guatemala border states. Results: A convergence path for type II diabetes mortality rates is found during the last 15 years between the studied border regions. Conclusions: The evidence presented indicates that the southern border states had been experiencing an epidemiologic transition towards mortality causes such as type II diabetes in the last decade. A trajectory that reflects a convergence pattern towards mortality rates found in the northern border states.Item Análisis espacial del diagnóstico tardío vs. mortalidad: una herramienta para apoyar estudios epidemiológicos sobre el cáncer. Villa Clara. Cuba 2004-2009(Población y Salud en Mesoamérica, Volumen 9, número 2 (enero-junio 2012), 2012) Batista Hernández, Norma E.; Antón Fleites, OscarFundamento: la tasa de mortalidad por cáncer en Villa Clara, al cierre del 2009, se mantuvo por encimade la media nacional, con ocurrencia significativa de mayor número de casos con diagnóstico tardío en fallecidos que en los sobrevivientes al período de estudio. Objetivo: mostrar las potencialidades del análisis espacio-temporal para identificar conglomerados espaciales y/o espacio-temporales que nos permitan el análisis del diagnóstico tardío como variable explicativa de la mortalidad, de las cinco localizaciones de cánceres bajo programa en la provincia. Métodos: estudio observacional descriptivo, focalizado en la detección de conglomerados espaciales y espacio-temporales del diagnostico tardío del cáncer en Villa Clara, utilizando una técnica estadística de exploración espacio-temporal (SaTScan v7.0.1.), la muestra abarcó la totalidad de pacientes diagnosticados durante el año 2004, y de estos, los fallecidos hasta el cierre del año 2009. Resultados: reveló la presencia de conglomerados significativos tanto espaciales como espacio-temporales, de las áreas de mayor riesgo de diagnóstico indeterminado. Conclusiones: demostró ser una buena herramienta para el análisis del diagnóstico tardío del cáncer, y permitió la generación de hipótesis sobre posibles determinantes que ayuden a orientar nuevas investigaciones.Item X-ray screening seems to reduce gastric cancer mortality by half in a community-controlled trial in Costa Rica(British Journal of Cancer 97, 2007) Rosero Bixby, Luis; Sierra Ramos, RafaelaX-ray screening of gastric cancer is broadly used in Japan, although no controlled trial has proved its effectiveness. This study evaluates the impact of an X-ray screening demonstrative intervention to reduce gastric cancer mortality in a Costa Rican region. The evaluation follows a quasi-experimental, community-controlled design, with measures before and after. About 7000 individuals participated by invitation in the two-wave screening programme. X-ray screening was followed by videoendoscopy and gastric biopsies. Treatment included resection with or without lymph node dissection. Comparisons with two control groups estimate that gastric cancer mortality was halved in the period from 2 to 7 years after the first screening visit. Validity of X-rays as used in this intervention had 88% sensitivity, 80% specificity, and 3% predictive value for individuals with two screening visits. Incidence in the screened group increased up to four times. Case survival was 85% in the intervention group after 5 years, compared to 12% among the controls before the intervention and 35% among the controls in the same region after the intervention. Although X-ray mass screening seems able to reduce stomach cancer mortality, its high cost may be an obstacle for scaling up this intervention in a nonrich country like Costa Rica.Item Differences in the association of cardiovascular risk factors with education: a comparison of Costa Rica (CRELES) and the USA (NHANES)(J Epidemiol Community Health 2010: 64, 2009) Rehkopf, David H.; Dow, William H.; Rosero Bixby, LuisBackground Despite different levels of economic development, Costa Rica and the USA have similar mortalities among adults. However, in the USA there are substantial differences in mortality by educational attainment, and in Costa Rica there are only minor differences. This contrast motivates an examination of behavioural and biological correlates underlying this difference. Methods The authors used data on adults aged 60 and above from the Costa Rican Longevity and Healthy Ageing Study (CRELES) (n¼2827) and from the US National Health and Nutrition Examination Survey (NHANES) (n¼5607) to analyse the cross-sectional association between educational level and the following risk factors for cardiovascular disease (CVD): ever smoked, current smoker, sedentary, high saturated fat, high carbohydrates, high calorie diet, obesity, severe obesity, large waist circumference, HDL cholesterol, LDL cholesterol, triglycerides, hemoglobin A1c, fasting glucose, C-reactive protein, systolic blood pressure and BMI. Results There were significantly fewer hazardous levels of risk biomarkers at higher levels of education for more than half (10 out of 17) of the risk factors in the USA, but for less than a third of the outcomes in Costa Rica (five out of 17). Conclusions These results are consistent with the context-specific nature of educational differences in risk factors for CVD and with a non-uniform nature of association of CVD risk factors with education within countries. Our results also demonstrate that social equity in mortality is achieved without uniform equity in all risk factors.Item Pulse blood pressure and cardiovascular mortality in a population-based cohort of elderly Costa Ricans(Journal of Human Hypertension; Volumen 30, Número 9, 2016) Rosero Bixby, Luis; Coto Yglesias, Fernando; Dow, William H.We studied the relationships between blood pressure (BP), pulse pressure (PP) and cardiovascular (CV) death in older adults using data from 2346 participants enrolled in the Costa Rican CRELES study, mean age 76 years (s.d. 10.2), 31% qualified as wide PP. All covariates included and analyzed were collected prospectively as part of a 4-year home-based follow-up; mortality was tracked for an additional 3 years, identifying 266 CV deaths. Longitudinal data revealed little change over time in systolic BP (SBP), a decline in diastolic BP, and widening of PP. Wide PP was associated with higher risk of CV death but only among individuals receiving antihypertensive drug therapy. Individuals with both wide PP and receiving therapy had 2.6 hazard rate of CV death relative to people with normal-PP plus not taking treatment (TRT), even adjusting for SBP. Increasing PP between visits was significantly associated to higher CV death independently of TRT status. SBP and DBP were not significantly associated to CV death when the effect of PP was controlled for. Conclusion: elderly hypertensive patients with wide or increasing PP, especially if receiving TRT, are the highest CV risk group, thus must be carefully assessed, monitored and treated with caution.