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Item Determinantes y diferencias del estado de salud entre regiones de Costa Rica = Determinants and differences of health status between geographic regions in Costa Rica(Población y Salud en Mesoamérica. Revista electrónica, Volumen 7, número 1, artículo 3, julio-diciembre, 2009) Morera Salas, Melvin; Aparicio LLanos, Amada; Xirinachs Salazar, Yanira; Hernández Villafuerte, Karla; Vargas Brenes Juan RafaelEl objetivo del documento es estudiar los determinantes de salud autopercibida entre regiones geográficas en Costa Rica. Se utiliza la Encuesta Nacional de Salud 2006 (ENSA 2006) para estimar las relaciones entre las diversas variables de carácter socioeconómico y el estado de salud autopercibido mediante un modelo probit ordenado. Los resultados muestran que después de ajustar por edad, sexo, variables socioeconómicos, de necesidad de salud y estilos de vida, existen diferencias de salud entre los individuos de las regiones costarricenses. No existen diferencias entre hombres y mujeres en el estado de salud, la educación formal prolongada se relaciona con mayor salud auto percibida, ciertos estilos de vida, considerados perjudiciales, no se relacionan con un menor grado de satisfacción, el padecimiento de una enfermedad crónica tiene efectos negativos y vivir en pareja tiene efectos positivos sobre la salud. The aim of this work is to study the determinants of self rated health between geographic regions in Costa Rica. The National Health Survey 2006 is used (ENSA 2006) to consider the relations between socioeconomic variables and the state of health by ordered probit model. Results show that after controlling by age, sex, socioeconomic characteristics, necessity of health and life styles, there are differences of health status between individuals of the Costa Rican regions. Do not exist differences between men and women in the health status, the prolonged formal education is positively related with a better health status, life styles considered detrimental for health are not related to bad health status, to suffer a chronic disease has negative effects and to live in pair haspositive effects on the health statusItem Demographic diversity and change in the Central American Isthmus(RAND, 1997) Pebley, Anne R.; Rosero Bixby, LuisThe chapters in this volume were originally presented at the International Conference on the Population of the Central American Isthmus, organized by the Central American Population Program (PCP) at the University of Costa Rica in collaboration with colleagues at RAND. Both the papers at the conference and the subset that are included in this volume represent research in a broad range of disciplines including demography, public health, anthropology, history, sociology, human ecology, and economics. The conference played an important role in bringing together an international group of researchers working on related issues in the region. The objective of this volume is to provide, in one central location, a collection of recent research on demographic, social, and environmental issues in the Central American Isthmus for English-speaking readers, both those who are not familiar with the region and those who know it well. For Spanish-speakers, the same collection of papers has been independently published as De los Mayas a la planificación familiar: DemografÍa del Istmo (L. Rosero Bixby, A. Pebley, and A. Bermúdez Méndez, editors) by the Editorial de la Universidad de Costa Rica. This book is the first English-language collection of recent research on demographic, social, and environmental issues in Central America. The region's experience with ethnic and cultural identity provides food for thought for scholars concerned with the meaning of ethnicity and the consequences of cultural change. Countries in the region also have grapppled with the complex issues of promoting economic growth and reducing poverty while avoiding environmental destruction. The chapters in this volume provide important and often novel insights into these and many other demographic, social, and policy issues in the Central American Isthmus. For the first time in the English language, Central America's rich demographic history comes into focus in this volume. Editors Anne R. Pebley and Luis Rosero-Bixby provide the first and only English translations of works originally presented at the International Conference on the Population of the Central American Isthmus. The chapters in this volume offer insights on a broad range of subjects, including estimates of the indigenous population, differences in education and earnings, trends in fertility and maternal and child health, migration, the environment, and many other demographic, social, and policy issues in the region.Item Health inequalities in the geographic distribution of dental practitioners in Costa Rica: an ecological study(Community Dentistry and Oral Epidemiology, Early view, 2023) Barboza Solís, Cristina; Barahona Cubillo, Juan; Fantin, Romain ClementResults: Mean national LPA was 6.5 full-time equivalents per 10 000 inhabitants, 3.4% of the Costa Rican population had no access to dentist; 12.9% had very low accessibil- ity, 22.7% had low accessibility, 35.0% had good accessibility, 16.2% had high accessi- bility, and 9.8% had very high accessibility. Overall, 39% of the population has a rather low accessibility. LPA was higher in urban districts compared to rural districts and in wealthiest districts compared to most disadvantaged districts. Within districts, after adjustment for district's characteristics, LPA was higher in urban MGU compared to rural MGU and in wealthiest MGU compared to most disadvantaged MGU. Conclusions: This study found that despite having a high number of dentists, their numbers are small in many areas, increasing inequalities in access to health care. The dentist's free establishment, where they can decide to provide private services within a community, creates zones with very high densities, in particular in the wealthiest urban areas, and others with very low densities, in particular the poorest rural areas. The lack of territorial planning has been one of the reasons that has encouraged an imbalance in the availability of dental human resources. To achieve effective universalItem Aggregation and insurance-mortality estimation(National Bureau of Economic Research, 2003) Dow, William H.; González, Kristine A.; Rosero Bixby, LuisOne goal of government health insurance programs is to improve health, yet little is known empirically about how important such government interventions can be in explaining health transitions. We analyze the child mortality effects of a major health insurance expansion in Costa Rica. In contrast to previous work in this area that has used aggregated ecological designs, we exploit census data to estimate individual-level models. Theoretical and empirical econometric results indicate that aggregation can introduce substantial upward biases in the insurance effects. Overall we find a statistically significant but quite small effect of health insurance on child mortality in Costa Rica.Item Insurance and other socioeconomic determinants of elderly longevity in a Costa Rican panel(Journal of Biosocial Science: 37(6), 2005) Rosero Bixby, Luis; Dow, William H.; Laclé Murray, AdrianaOfficial figures show that life expectancy in Costa Rica is longer than in the United States (US), in spite of the fact that per capita health expenditure is only one-tenth that of the US. To check whether this is for real and to explore some of its determinants, 900 Costa Ricans aged 60+ were followed from 1984 to 2001. Follow-up household visits were made, deaths were tracked in the national death registry, and survival status in the voting registry was double-checked. In addition, the survivors were contacted in 2002. Two-thirds of the panel had died by December 2001. Kaplan—Meier curves, life tables and Cox regression were used to analyse the panel's survival. Mortality in the panel was slightly higher than the Costa Rican average and similar to that in the US, confirming the exceptional longevity of Costa Ricans. Survival was substantially lower among unmarried men and individuals with limited autonomy at the beginning of the study. The effect of socioeconomic status is weak. Insurance effects seem to be confounded by selection biases.Item Red social y salud del adulto mayor en perspectiva comparada: Costa Rica, España e Inglaterra(Población y Salud en Mesoamérica; Volumen 5, Número 1, 2007) Puga, Dolores; Rosero Bixby, Luis; Glaser, Karen; Castro Martín, TeresaEn el presente trabajo se explora la relación entre la red social más próxima al adulto mayor, los vínculos establecidos con otros miembros del hogar y con los hijos, y las condiciones de salud en la vejez, desde una perspectiva internacional comparada. Para ello se cuenta con evidencias empíricas de una sociedad latinoamericana (costarricense), una sociedad latino-europea (española) y una sociedad anglosajona (británica). Los adultos mayores de los tres países analizados han mostrado modelos de redes familiares claramente diferenciados, caracterizados por la corresidencia intergeneracional (caso latinoamericano), por la independencia (caso anglosajón) y por la independencia (sólo) residencial (caso latino-europeo). La convivencia entre miembros de la misma familia parece tener efectos positivos cuando no es por necesidad. La frecuencia de los contactos con otros miembros de la familia muestra un mayor efecto positivo cuanto mayor es la independencia de los adultos mayores.Item Estilos de vida y factores de riesgo para la salud de las personas adultas mayores del proyecto CRELES - Costa Rica 2004-2006(Población y Salud en Mesoamérica; Volumen 5, Número 1, 2007) Fernández Rojas, Xinia Elena; Méndez Chacón, ErickaEnvejecimiento saludable es sinónimo de envejecimiento sin discapacidad. Este ha sido asociado a mejoras en la nutrición, la actividad física y al control adecuado de factores de riesgo como el hábito de fumar, consumo de bebidas alcohólicas, así como el evitar o reducir el aislamiento social y mental. El presente artículo describe los estilos de vida y riesgos de la salud de las personas adultas mayores del Estudio Longitudinal de Envejecimiento Saludable de Costa Rica (CRELES), obtenidos de los participantes de la primera ronda realizada entre el 2004 y el 2006. Los resultados obtenidos describen características de riesgo diferenciadas por sexo, donde las mujeres presentan mayor obesidad, circunferencia abdominal, depresión o riesgo de depresión, deterioro cognitivo, mayor numero de limitaciones físicas, mayor numero sin pareja, y en general una auto percepción de su salud como de regular a mala. Por su parte los hombres, presentan menor obesidad, menor circunferencia abdominal, un porcentaje mayor con consumos menores a 2000 calorías por día, y son más activos, todo esto a pesar de reprtar mayor fumado y mayor consumo de bebidas alcohólicas. En general, los resultados apuntan a menores riesgos para la salud en los adultos mayores de sexo masculino.Item Los dividendos demográficos y la economía del ciclo vital en Costa Rica(Papeles de Población 14(55), 2008) Rosero Bixby, Luis; Robles Soto, ArodysThere are two identified dividends or demographic bonuses derived from the Costa Rica’s change of population’s age structure and vital cycle’s profile. The first dividend comes from the saving and actives’ accumulation of the adults to support their consumption needs in an old age, now commonly long. Almost all of the country’s meager economic growth in the last twenty-five years could be caused by the first dividend. The second dividend can provide Costa Rica with a base of an annual 0.5 percent of economic growth, at least. There are two identified peculiarities in the Costa Rica’s vital cycle: high public transfers towards the elderly and an intergenerational transfers’ flow inverted as from the 75 years of age. Se identifican dos dividendos o bonos demográficos derivados del cambio en la estructura por edades de la población y del perfil del ciclo vital de los costarricenses. El primer dividendo proviene del aumento más rápido de los productores en comparación con los consumidores. El segundo proviene del ahorro y acumulación de activos de los adultos para atender sus necesidades de consumo en una vejez cada vez más prolongada. Casi todo el magro crecimiento económico del país del último cuarto de siglo podría deberse al primer dividendo. El segundo dividendo puede dar a Costa Rica un piso de 0.5 por ciento anual de crecimiento económico como mínimo. Se identifican dos peculiaridades del ciclo vital en Costa Rica: elevadas transferencias públicas hacia los adultos mayores y un flujo de transferencias intergeneracionales que se invierte a partir de los 75 años de edad.Item Do biological measures mediate the relationship between education and health : a comparative study(Social Science & Medicine 72 (2011), 2010) Goldman, Noreen; Turra, Cassio M.; Rosero Bixby, Luis; Weir, David; Crimmins, EileenDespite a myriad of studies examining the relationship between socioeconomic status and health outcomes, few have assessed the extent to which biological markers of chronic disease account for social disparities in health. Studies that have examined this issue have generally been based on surveys in wealthy countries that include a small set of clinicalmarkers of cardiovascular disease. The availability of recent data from nationally representative surveys of older adults in Costa Rica and Taiwan that collected a rich set of biomarkers comparable to those in a recent US survey permits us to explore these associations across diverse populations. Similar regression models were estimated on three data setsethe Social Environment and Biomarkers of Aging Study in Taiwan, the Costa Rican Study on Longevity and Healthy Aging, and the Health and Retirement Study in the USA e in order to assess (1) the strength of the associations between educational attainment and a broad range of biomarkers; and (2) the extent to which these biomarkers account for the relationships between education and two measures of health status (self-rated health, functional limitations) in older populations. The estimates suggest non-systematic and weak associations between education and high risk biomarker values in Taiwan and Costa Rica, in contrast to generally negative and significant associations in the US, especially among women. The results also reveal negligible or modest contributions of the biomarkers to educational disparities in the health outcomes. The findings are generally consistent with previous research suggesting stronger associations between socioeconomic status and health in wealthy countries than in middle-income countries and may reflect higher levels of social stratification in the US. With access to an increasing number of longitudinal biosocial surveys, researchers may be better able to distinguish true variations in the relationship between socioeconomic status and health across different settings from methodological differences.Item Major cardiovascular risk factors in Latin America: a comparison with the United States. The Latin American consortium of studies in obesity (LASO)(PLOS ONE, vol.8(1), 2013) Miranda Montero, Jaime J.; Herrera Galindo, Víctor Mauricio; Chirinos Medina, Julio A.; Gómez Gutiérrez, Luis Fernando; Perel, Pablo; Pichardo Estevez, Rafael; González Medina, Angel; Sánchez Abanro, José Ramón; Ferreccio, Catterina; Aguilera Sanhueza, Ximena; Silva, Eglé; Oróstegui, Myriam; Medina Lezama, Josefina; Pérez, Cynthia M.; Suárez, Erick; Ortiz Martínez, Ana Patricia; Rosero Bixby, Luis; Schapochnik, Noberto; Ortiz, Zulma; Ferrante, Daniel; Casas, Juan P.; Bautista Lorenzo, Leonelo EnriqueLimited knowledge on the prevalence and distribution of risk factors impairs the planning and implementation of cardiovascular prevention programs in the Latin American and Caribbean (LAC) region. For the last two decades cardiovascular diseases have been the main cause of death in Latin America and the Caribbean (LAC). [1] Cardiovascular mortality rates continue to increase in most LAC countries, and in those countries where rates have declined the blunting of the trend has been considerably lower than in the United Sates (US). [2]. Data on the distribution of cardiovascular risk factors in LAC region are limited, and the few studies available show significant variation in the levels of prevalence. For instance, the CARMELA study, [3] conducted in seven major urban cities from LAC, reprted markedly different hypertension levels. For instance, hypertension prevalence in Santiago (Chile), Buenos Aires (Argentina), and Barquisimeto (Venezuela), ranged from 24% to 29%, whereas in Quito (Ecuador), Bogotá (Colombia), Mexico City (Mexico), and Lima (Peru) varied from 9% to 13%. Yet, diabetes prevalence in these cities was similar to world’s estimates, around 7%. [3] Differences in rural-urban residence, socioeconomic development, and internal migration patterns could partly explain the contrasting profiles of cardiovascular risk factors, but knowledge on this regard is also very limited. This scarcity of data on the distribution of risk factors and, in turn, on their impact on incidence and mortality hampers efforts to curtail the growing epidemic of cardiovascular disease in LAC. In fact, national and regional health policies have been customarily based on estimates of the burden of risk factors and disease that rely heavily on demographic profiles. [4]. Here we reprt the distribution of cardiovascular risk factors using data from population-based studies from eight LAC countries. We also compare the distribution of cardiovascular risk factors in LAC and the US, as a way to illustrate the current stage of LAC in the process of the epidemiological transition. Insight into the specific differences in the distribution of risk factors in the LAC and US populations is important to foresee future trends in cardiovascular morbidity and mortality in the region.