A nation-wide analysis of socioeconomic and geographical disparities in the prevalence of obesity and excess weight in children and adolescents in Spain: Results from the ENE-COVID study.

OBJECTIVE: To estimate national and provincial prevalence of obesity and excess weight in the child and adolescent population in Spain by sex and sociodemographic characteristics, and to explore sources of inequalities in their distribution, and their geographical patterns. METHODS: ENE-COVID is a nationwide representative seroepidemiological survey (68 287 participants) stratified by province and municipality size (April-June 2020). Participants answered a questionnaire which collected self-reported weight and height, that allowed estimating crude and model-based standardized prevalences of obesity and excess weight in the 10 543 child and adolescent participants aged 2-17 years. RESULTS: Crude prevalences (WHO growth reference) were higher in boys than in girls (obesity: 13.4% vs. 7.9%; excess weight: 33.7% vs. 26.0%; severe obesity: 2.9% vs. 1.2%). These prevalences varied with age, increased with the presence of any adult with excess weight in the household, while they decreased with higher adult educational and census tract average income levels. Obesity by province ranged 1.8%-30.5% in boys and 0%-17.6% in girls; excess weight ranged 15.2%-49.9% in boys and 10.8%-40.8% in girls. The lowest prevalences of obesity and excess weight were found in provinces in the northern half of Spain. Sociodemographic characteristics only partially explained the observed geographical variability (33.6% obesity; 44.2% excess weight). CONCLUSIONS: Childhood and adolescent obesity and excess weight are highly prevalent in Spain, with relevant sex, sociodemographic and geographical differences. The geographic variability explained by sociodemographic variables indicates that there are other potentially modifiable factors on which to focus interventions at different geographic levels to fight this problem.

Racial Differences in Sudden Cardiac Death.

BACKGROUND: Blacks have a higher incidence of out-of-hospital sudden cardiac death (SCD) in comparison with whites. However, the racial differences in the cumulative risk of SCD and the reasons for these differences have not been assessed in large-scale community-based cohorts. The objective of this study is to compare the lifetime cumulative risk of SCD among blacks and whites, and to evaluate the risk factors that may explain racial differences in SCD risk in the general population. METHODS: This is a cohort study of 3832 blacks and 11 237 whites participating in the Atherosclerosis Risk in Communities Study (ARIC). Race was self-reported. SCD was defined as a sudden pulseless condition from a cardiac cause in a previously stable individual, and SCD cases were adjudicated by an expert committee. Cumulative incidence was computed using competing risk models. Potential mediators included demographic and socioeconomic factors, cardiovascular risk factors, presence of coronary heart disease, and electrocardiographic parameters as time-varying factors. RESULTS: The mean (SD) age was 53.6 (5.8) years for blacks and 54.4 (5.7) years for whites. During 27.4 years of follow-up, 215 blacks and 332 whites experienced SCD. The lifetime cumulative incidence of SCD at age 85 years was 9.6, 6.6, 6.5, and 2.3% for black men, black women, white men, and white women, respectively. The sex-adjusted hazard ratio for SCD comparing blacks with whites was 2.12 (95% CI, 1.79-2.51). The association was attenuated but still statistically significant in fully adjusted models (hazard ratio, 1.38; 95% CI, 1.11-1.71). In mediation analysis, known factors explained 65.3% (95% CI 37.9-92.8%) of the excess risk of SCD in blacks in comparison with whites. The single most important factor explaining this difference was income (50.5%), followed by education (19.1%), hypertension (22.1%), and diabetes mellitus (19.6%). Racial differences were evident in both genders but stronger in women than in men. CONCLUSIONS: Blacks had a much higher risk for SCD in comparison with whites, particularly among women. Income, education, and traditional risk factors explained ≈65% of the race difference in SCD. The high burden of SCD and the racial-gender disparities observed in our study represent a major public health and clinical problem.

Discordance between physician-rated health and an objective health measure among institutionalized older people.

BACKGROUND: Although physician-rated health is emerging as a potentially useful variable in research, with implications in practice, it has not been analyzed. Moreover, one of its most important aspects, namely, concordance with patients' objective health state, has not been investigated. This study sought to measure concordance between physician-rated health and an objective health measure, and assess both measures' validity in predicting death. METHODS: The data for the study were drawn from a 1998-1999 survey and subsequent mortality follow-up of residential and nursing homes in Madrid (Spain). Study subjects were 630 residents aged ≥65 years, and their respective facility physicians. Measures included agreement between physicians' rating of residents' overall health (good, intermediate or poor) and an objective measure of residents' health (good, intermediate or poor), based on functional capacity, cognitive status, and number of chronic conditions. Overrating was defined as any case where health, rated as good by a physician, was objectively rated as poor. RESULTS: Whereas 45% of physicians and 55% of residents rated their health as good, only 4% of such residents had good objective health. Of those who received a physician rating of good/very good health, 39.0% had poor objective health. There was evidence of clear overrating in 18% of the population, and clear to moderate overrating in 73% of the population. In terms of power to predict mortality, the pattern of behavior shown by the objective health measure was good, graded and congruent, and better than that shown by physician-rated health. CONCLUSION: Physician overrating of the overall health of older persons in residential and nursing homes, would appear to be very high. Although some degree of contextualization by physicians in this setting might be considered reasonable, the degree of overrating in our population seems nevertheless excessive.

ICF-based disability survey in a rural population of adults and older adults living in Cinco Villas, Northeastern Spain: design, methods and population characteristics.

BACKGROUND: This article describes the methods of a door-to-door screening survey exploring the distribution of disability and its major determinants in northeastern Spain. This study will set the basis for the development of disability-related services for the rural elderly in northeastern Spain. METHODS: The probabilistic sample was composed of 1,354 de facto residents from a population of 12,784 Social Security card holders (age: > or = 50 years). Cognitive and disability screenings were conducted (period: June 2008-June 2009). Screening instruments were the MMSE and the World Health Organization Disability Assessment Schedule. Participants screened positive for disability underwent an assessment protocol focusing on primary care diagnoses, disability, lifestyle, and social and health service usage. Participants screened positive for cognitive functioning went through in-depth neurological evaluation. RESULTS: The study sample is described. Usable data were available for 1,216 participants. A total of 625 individuals (51.4%) scored within the positive range in the disability screening, while 135 (11.1%) scored within the positive range of the cognitive screening. The proportion of positively screened individuals was higher for women and increased with age. CONCLUSIONS: Screening surveys represent a feasible design for examining the distribution of disability and its determinants among the elderly. Data quality may benefit from methodological developments tailored to rural populations with a low education level.

Factors associated with self-rated health in older people living in institutions.

BACKGROUND: Although self-rated health has been extensively studied in community older people, its determinants have seldom been investigated in institutional settings. We carried out a cross-sectional study to describe the physical, mental, and social factors associated with self-rated health in nursing homes and other geriatric facilities. METHODS: A representative sample of 800 subjects 65 years of age and older living in 19 public and 30 private institutions of Madrid was randomly selected through stratified cluster sampling. Residents, caregivers, physicians, and nurses were interviewed by trained geriatricians using standardized instruments to assess self-rated health, chronic illnesses, functional capacity, cognitive status, depressive symptoms, vision and hearing problems, and social support. RESULTS: Of the 669 interviewed residents (response rate 84%), 55% rated their health as good or very good. There was no association with sex or age. Residents in private facilities and those who completed primary education had significantly better health perception. The adjusted odds ratio (95% confidence interval) for worse health perception was 1.18 (1.07-1.28) for each additional chronic condition, 2.37 (1.38-4.06) when comparing residents with moderate dependency to those functionally independent, and 10.45 (5.84-18.68) when comparing residents with moderate/severe depressive symptoms to those without symptoms. Visual problems were also associated with worse health perception. Similar results were obtained in subgroup analyses, except for inconsistencies in cognitively impaired individuals. CONCLUSION: Chronic conditions, functional status, depressive symptoms and socioeconomic factors were the main determinants of perceived health among Spanish institutionalized elderly persons. Doubts remain about the proper assessment of subjective health in residents with altered cognition.