Accessing medical care for infertility: a study of women in Mexico.

Objective: To investigate barriers in accessing care for infertility in Mexico, because little is known about this issue for low and middle-income countries, which comprise 80% of the world's population. Design: Cross-sectional analysis. Setting: Mexcian Teachers' Cohort. Patients: A total of 115,315 female public school teachers from 12 states in Mexico. Interventions: None. Main Outcome Measures: The participants were asked detailed questions about their demographics, lifestyle characteristics, access to the health care system, and infertility history via a self-reported questionnaire. Log-binomial models, adjusted a priori for potential confounding factors, were used to estimate the prevalence ratios (PRs) and 95% confidence intervals ( CIs) of accessing medical care for infertility among women reporting a history of infertility. Results: A total of 19,580 (17%) participants reported a history of infertility. Of those who experienced infertility, 12,470 (63.7%) reported seeking medical care for infertility, among whom 8,467 (67.9%) reported undergoing fertility treatments. Among women who reported a history of infertility, women who taught in a rural school (PR, 0.95; 95% CI, 0.92-0.97), spoke an indigenous language (PR, 0.88; 95% CI, 0.84-0.92), or had less than a university degree (PR, 0.93; 95% CI, 0.90-0.97) were less likely to access medical care for fertility. Women who had ever had a mammogram (PR, 1.07; 95% CI, 1.05-1.10), had a pap smear in the past year (PR, 1.08; 95% CI, 1.06-1.10), or who had used private health care regularly or in times of illness were more likely to access medical care for fertility. Conclusions: The usage of infertility care varied by demographic, lifestyle, and access characteristics, including speaking an indigenous language, teaching in a rural school, and having a private health care provider.

Changes in Sugar-Sweetened Soda Consumption, Weight, and Waist Circumference: 2-Year Cohort of Mexican Women.

OBJECTIVES: To evaluate 2-year changes in soda consumption, weight, and waist circumference. METHODS: We followed 11 218 women from the Mexican Teachers' Cohort from 2006 to 2008. Dietary data were collected using a semiquantitative food frequency questionnaire. Weight was self-reported, and waist circumference was self-measured. We used linear regression to evaluate changes in sugar-sweetened and sugar-free soda consumption in relation to changes in weight and waist circumference, adjusting for lifestyle and other dietary factors. RESULTS: Compared with no change, a decrease in sugar-sweetened soda consumption by more than 1 serving per week was associated with less weight gain (-0.4 kg; 95% confidence interval [CI] = -0.6, -0.2). Conversely, relative to no change, an increase in sugar-sweetened soda by more than 1 serving per week was associated with a 0.3-kilogram (95% CI = 0.2, 0.5) increase in weight. An increase of 1 serving per day of sugar-sweetened soda was associated with a 1.0 kg (95% CI = 0.7, 1.2; P < .001) increase in weight. The results for waist circumference were similar. CONCLUSIONS: Moderate changes in consumption of sugar-sweetened soda over a 2-year period were associated with corresponding changes in weight and waist circumference among Mexican women.

Socioeconomic position and markers of adiposity among female teachers in Mexico.

BACKGROUND: Occupation is often used as an indicator of socioeconomic position (SEP) in epidemiological studies, although it is unclear whether variation in SEP within a single occupational group is associated with health outcomes, including adiposity measures. METHODS: We created a multidimensional SEP index using principal component analysis based on self-reported data from 36 704 female teachers in Mexico from 2008 to 2011. Multivariable Poisson regression models with robust variance were used to evaluate cross-sectional associations of SEP and markers of adiposity, including obesity (body mass index (BMI) ≥30 kg/m2), elevated waist-to-hip ratio (WHR >85) and high waist circumference (WC >88 cm). RESULTS: The most relevant indicators of SEP in this study were internet access and private health insurance. We observed significant inverse trends in obesity, WHR and WC in relation to SEP (all ptrend<0.001). Compared with women with low SEP, women in the middle (prevalence ratio (PR) 0.97, 95% CI 0.93 to 1.02) and high (PR 0.85, 95% CI 0.81 to 0.90) SEP tertiles were less likely to be obese in multivariable models. Results were similar in models of WHR and WC adjusting for BMI. For example, women with high versus low SEP were 14% less likely to have an elevated WHR (PR 0.86, 95% CI 0.83 to 0.89) and 7% less likely to have a high WC (PR 0.93, 95% CI 0.89 to 0.97). CONCLUSIONS: Our findings suggest that SEP remains relevant for adiposity within a single occupational setting and indicate that a stronger conceptualisation of SEP in epidemiological studies may be warranted.

Risk factors for urinary incontinence among postmenopausal Mexican women.

INTRODUCTION AND HYPOTHESIS: Previous studies of racial/ethnic variation in urinary incontinence (UI) suggest that population-specific studies of UI risk factors are needed to develop appropriate public health recommendations. We assessed UI risk factors among postmenopausal Mexican women enrolled in the Mexican Teachers' Cohort. METHODS: We conducted a cross-sectional study among 15,296 postmenopausal women who completed the 2008 questionnaire. UI cases were women who reported experiencing UI during menopause. Self-reported potential UI risk factors included age, reproductive variables, smoking status, adiposity, and several health conditions. We estimated multivariate-adjusted odds ratios (ORs) and 95 % confidence intervals (CIs) for UI using multivariable logistic regression. RESULTS: Among these postmenopausal women, the prevalence of UI was 14 %. Odds of UI were higher among women with ≥4 children vs nulliparous women (OR 1.43, 95 % CI 1.04-1.96) or body mass index (BMI) ≥30 vs <22 kg/m2 (OR 2.00, 95 % CI: 1.55-2.57). Age at first birth <20 vs 20-24 years, past or current vs never smoking, larger waist-to-hip ratio, and history of asthma, high blood pressure, or diabetes were also associated with higher odds of UI (OR 1.2-1.3). We found a trend of lower odds of UI with older age. CONCLUSIONS: Our data suggest that information about UI and UI prevention strategies might be particularly useful for Mexican postmenopausal women with 4 or more children or higher BMI. Further studies with longitudinal UI data, in addition to data on UI severity and subtype, are needed to provide more specific information about UI risk factors to Mexican women.

Bone mineral density and mammographic density in Mexican women.

BACKGROUND: Bone mineral density (BMD) is a putative marker for lifetime exposure to estrogen. Studies that have explored whether BMD is a determinant of mammographic density (MD) have observed inconsistent results. Therefore,we examined this potential association in a sample of women (n = 1,516) from the clinical sub-cohort in the Mexican teachers' cohort (n = 115,315). METHODS: We used multivariable linear regression to assess the association between quartiles of BMD and percent MD, as well as total dense and non-dense area of the breast, stratified by menopausal status. We also examined the associations by body mass index (BMI) (< 30 kg/m(2), ≥ 30 kg/m(2)). RESULTS: Overall, there was no association between BMD and MD among premenopausal women. However, when we stratified by BMI, there was a modest inverse association between BMD and percent MD (difference between extreme quartiles = -2.8, 95 % CI -5.9, 0.27, p trend = 0.04) among women with BMI < 30 kg/m(2), but a positive association among obese women (comparable difference = 5.1, 95 % CI 0.02, 10.1, p trend = 0.03;p interaction < 0.01). Among postmenopausal women, BMD and percent MD were positively associated after adjustment for BMI (p trend < 0.01). Postmenopausal women in the highest two quartiles of BMD had 4­5 % point higher percent MD compared to women in the lowest quartile. The association did not differ by BMI in postmenopausal women (p interaction = 0.76). CONCLUSION: Among obese premenopausal women as well as postmenopausal women, BMD was positively associated with percent MD. Among leaner premenopausal women, BMD and percent MD were modestly inversely associated. These findings support the hypothesis that cumulative exposure to estrogen (as measured by BMD) may influence MD.

Reproductive and lifestyle risk factors and mammographic density in Mexican women.

PURPOSE: Several breast cancer risk factors have been consistently associated with mammographic density (MD); however, data are limited for Hispanic women. METHODS: We examined data from 1007 premenopausal and 600 postmenopausal women in the Mexican Teachers' Cohort. Multivariable linear regression was used to estimate associations between risk factors and MD. RESULTS: Among premenopausal women, age, current body mass index (BMI), BMI at age 18 years, and weight change since age 18 years were inversely associated with percent MD, whereas benign breast disease, alcohol intake, and breastfeeding 12 months or more were associated with higher percent MD. Among postmenopausal women, age, current BMI, BMI at age 18 years, weight change since age 18 years, and speaking or having parents who speak an indigenous language were inversely associated with percent MD, whereas benign breast disease and greater age at natural menopause were positively associated with percent MD. Other breast cancer risk factors, such as age at menarche, parity, and age at first pregnancy, were not significantly associated with density in either premenopausal or postmenopausal women. CONCLUSIONS: Results from the Mexican Teachers' Cohort are generally consistent with predictors of mammographic density observed in primarily non-Hispanic white populations; however, certain risk factors (e.g., parity) were not significantly associated with MD.

Restless Legs Syndrome and Hypertension in Mexican Women.

BACKGROUND: RLS is a common chronic disorder characterized by an irresistible need to move the lower limbs that affects sleep. Poor sleep has been associated with increased blood pressure (BP). Thus, we evaluated the cross-sectional relationship between RLS and hypertension (HTN) in a large cohort study in Mexico. METHODS: In 2011, 54,925 female participants from the Mexican Teachers' Cohort responded to a four-item questionnaire based on the International Restless Legs Syndrome Study Group's minimal diagnostic criteria. Women also reported diagnosis and treatment of HTN. We used multivariable logistic regression models to estimate prevalence odds ratios (ORs) for HTN, adjusting for lifestyle and dietary factors. We also estimated adjusted prevalence ORs for HTN by frequency of RLS symptoms. RESULTS: We identified 9,230 cases (17%) of RLS, and the prevalence of HTN was 13.1% among women with RLS and 9.4% among those without RLS. The multivariable-adjusted prevalence OR for HTN comparing women with to those without RLS was 1.18 (95% confidence interval [CI]: 1.10-1.26). Compared to those without RLS, the prevalence OR of HTN in women reporting a symptom frequency of once a month or less was 1.14 (95% CI: 1.00-1.30); among those with symptoms two to four times a month, the OR was 1.17 (95% CI: 1.05-1.30); and for those with symptoms at least two times a week, the OR was 1.22 (95% CI: 1.10-1.35). CONCLUSION: We observed an association between RLS and HTN. Future studies should evaluate the impact of treating RLS on BP.

Metabolic syndrome and mammographic density in Mexican women.

Metabolic syndrome has been associated with an increased risk of breast cancer; however, little is known about the association between metabolic syndrome and percent mammographic density, a strong predictor of breast cancer. We analyzed cross-sectional data from 789 premenopausal and 322 postmenopausal women in the Mexican Teacher's Cohort (ESMaestras). Metabolic syndrome was defined according to the harmonized definition. We measured percent density on mammograms using a computer-assisted thresholding method. Multivariable linear regression was used to estimate the association between density and metabolic syndrome, as well as its components by state (Jalisco, Veracruz) and menopausal status (premenopausal, postmenopausal). Among premenopausal women in Jalisco, women with metabolic syndrome had higher percent density than those without after adjusting for potential confounders including BMI [difference = 4.76; 95% confidence interval (CI), 1.72-7.81]. Among the metabolic syndrome components, only low high-density lipoprotein levels (<50 mg/dL) were associated with significantly higher percent density among premenopausal women in Jalisco (difference = 4.62; 95% CI, 1.73-7.52). Metabolic syndrome was not associated with percent density among premenopausal women in Veracruz (difference = -2.91; 95% CI, -7.19 to 1.38), nor among postmenopausal women in either state. Metabolic syndrome was associated with higher percent density among premenopausal women in Jalisco, Mexico, but was not associated with percent density among premenopausal women in Veracruz, Mexico, or among postmenopausal women in either Jalisco or Veracruz. These findings provide some support for a possible role of metabolic syndrome in mammographic density among premenopausal women; however, results were inconsistent across states and require further confirmation in larger studies.

Body size throughout the life course and mammographic density in Mexican women.

Mammographic density (MD) is a strong risk factor for breast cancer, but the biological mechanism underlying this association is not clear. Current adult body mass index (BMI) is inversely associated with percent MD; however, few studies have included Hispanic women or evaluated associations with measures of body fatness earlier in life. ESMaestras was established in 2006, when 28,345 women ages ≥35 responded to a detailed questionnaire that assessed possible disease risk factors, including body fatness in childhood, adolescence, and young adulthood. In 2007, 2084 ESMaestras participants underwent a clinical examination, which included measurements of weight, height, and sitting height and a mammogram. We measured percent MD using a computer-assisted method. The current analysis includes 972 premenopausal and 559 postmenopausal women. We used multivariable linear regression to evaluate associations between measures of body size and MD, independent of current BMI. Among pre- and postmenopausal women, we observed no significant associations between body fatness during childhood, adolescence, or young adulthood and percent MD. Among postmenopausal women, we observed a modest positive association between body fatness immediately before first pregnancy and between ages 25 and 35 after adjustment for current BMI, with differences of 4.9 and 3.6 % points, respectively, in percent MD between the heaviest and leanest women (p-trend = 0.02). There were no significant associations between height, sitting height, and percent MD among pre- or postmenopausal women in multivariable models adjusting for BMI. In general, we found no clear associations between measures of body size in early life, current sitting height, or current height, and percent MD, after adjusting for current BMI, in this population of Mexican women. Our observation of a positive association between early adult body fatness (i.e., before first pregnancy and ages 25-35) and percent MD among postmenopausal women is inconsistent with prior research and requires confirmation in other studies.