Mortalidad y Morbilidad
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Item Diabetes mellitus en adultos mayores costarricenses(Población y Salud en Mesoamérica. Revista Electrónica, Vol. 5(1), artículo 2, 2007) Brenes Camacho, Gilbert; Rosero Bixby, LuisPoblación y Salud en Mesoamérica - Volumen 5, número 1, artículo 2, jul - dic 2007 Número especial CRELES - Costa Rica: Estudio de Longevidad y Envejecimiento Saludable http://ccp.ucr.ac.cr/revista/ 2Diabetes mellitus en adultos mayores costarricenses1Gilbert Brenes-Camacho2, Luis Rosero-Bixby3RESUMEN El propósito del artículo es describir la prevalencia de la diabetes mellitus (DM) entre los adultos mayores costarricenses. Se analiza la magnitud de la prevalencia, los problemas de medición de la misma, así como los factores asociados con la enfermedad, la enfermedad controlada, y el tener niveles altos de hemoglobina glicosilada (HbA1C) entre la población sin diagnóstico previo de DM. Una cuarta parte de los adultos mayores de Costa Rica padecen de DM y cerca de la mitad de los que la padecen, no la tienen controlada. Los factores asociados con la prevalencia de la enfermedad son los usuales destacados por la literatura científica: actividad física, obesidad e historia familiar de DM. Se halla evidencia de un posible problema de acceso diferencial a servicios de control de DM, ya que los adultos mayores que habitan fuera de la gran área metropolitana de San José tienen un riesgo menor de tener controlada su enfermedad. Los adultos mayores sin pensión también tienen un riesgo mayor de tener niveles altos de HbA1C.Item Genetic, dietary, and other lifestyle determinants of serum homocysteine levels in young adults in Costa Rica(Revista Panamericana de Salud Pública, vol17(4), 2005) Holst Schumacher, Ileana; Monge Rojas, Rafael; Cambronero Gutiérrez, Priscilla; Brenes Camacho, GilbertObjective: Elevated serum total homocysteine (tHcy) is considered an independent risk factor for cardiovascular disease. The objective of this study was to develop the first-ever information on the prevalence of hyperhomocysteinemia and its determinants in a population in Costa Rica. Methods: A cross-sectional study was conducted to determine serum levels of tHcy, vitamin B12, folate and creatinine, as well as the presence of the genotype TT for the methylentetratrahydrofolate reductase (MTHFR) enzyme. Additionally, dietary vitamin intakes and other lifestyle risk factors were assessed. A total of 399 Costa Rican adults from the central valley of the country (where the capital city, San José, is located), aged 20 to 40 years, participated in this study in the year 2000. Analyses of variance were performed for continuous variables, and the chi-square test was used for categorical data. Spearman correlation tests were calculated to determine associations between variables. Three linear regression analyses and one binary logistic model were developed in order to determine the predictors for homocysteine levels in the population studied. Results: The overall prevalence of hyperhomocysteinemia ( over 15 umol/L) in the population was 6%, 31% of the population were in the range of 10 to 15 umol/L, 29% had the genotype TT for the enzyme MTHFR, 18% presented a vitamin B12 deficiency ( less 165 pmol/L), and none of the persons had low serum folate levels (less 7,0 nmol/l). No significant associations were found between tHcy and age, smoking, consuming alcohol, or dietary vitamin intake. Conclusions: Only serum vitamin B12 levels and the genotype TT of the enzyme MTHFR were considered significant predictors of high serum tHcy levels in the Costa Rica population studied.Item Prevalencia de hipertensión en adultos mayores de Costa Rica(Población y Salud en Mesoamérica; Volumen 5, Número 1, 2007) Méndez Chacón, Ericka; Rosero Bixby, LuisEste artículo estima la prevalencia de hipertensión (controlada y con o sin diagnóstico previo) entre los adultos mayores costarricenses. Valora los problemas de medición y explora los factores asociados con la enfermedad. Se utilizan datos de una muestra nacional representativa del proyecto CRELES: Costa Rica: Estudio de Longevidad y Envejecimiento Saludable. Se realizaron dos mediciones de la presión arterial con monitores digitales a una muestra de 3000 adultos y se registró el auto reprte de la enfermedad y el uso de medicamentos antihipertensivos. La segunda medición resultó en valores significativamente menores tanto para la presión diastólica como para la sistólica. No se detectaron sesgos en la medición realizada por entrevistador ni por trimestre de trabajo de campo. El 59% de los adultos mayores del país sufre de hipertensión (HTA). La prevalencia es mayor entre las mujeres que entre los hombres. El 16% de todos los adultos mayores no tenían diagnóstico previo de HTA pero en nuestras mediciones resultaron con HTA. Los principales co-factores de HTA identificados en este artículo son: edad, estar asegurado, el índice de masa corporal, los antecedentes familiares, tener menos de 6 años de educación formal, ser fumador activo y consumir más de 3000 calorías al día.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 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.