Aging and self-reported health in 114 Latin American cities: gender and socio-economic inequalities.

BACKGROUND: Understanding how urban environments influence people's health, especially as individuals age, can help identify ways to improve health in the rapidly urbanizing and rapidly aging populations. OBJECTIVES: To investigate the association between age and self-reported health (SRH) in adults living in Latin-American cities and whether gender and city-level socioeconomic characteristics modify this association. METHODS: Cross-sectional analyses of 71,541 adults aged 25-97 years, from 114 cities in 6 countries (Argentina, Brazil, Colombia, Chile, El Salvador, and Guatemala), as part of the Salud Urbana en America Latina (SALURBAL) Project. We used individual-level age, gender, education, and self-reported health (SRH) data from harmonized health surveys. As proxies for socioeconomic environment we used a city-level socioeconomic index (SEI) calculated from census data, and gross domestic product (GDP) per-capita. Multilevel Poisson models with a robust variance were used to estimate relative risks (RR), with individuals nested in cities and binary SRH (poor SHR vs. good SRH) as the outcome. We examined effect modification by gender and city-level socioeconomic indicators. RESULTS: Overall, 31.4% of the sample reported poor SRH. After adjusting for individual-level education, men had a lower risk of poor SRH (RR = 0.76; CI 0.73-0.78) compared to women, and gender modified the association between age and poor SRH (p-value of interaction < 0.001). In gender stratified models, the association between older age and poor SRH was more pronounced in men than in women, and in those aged 25-65 than among those 65+ (RR/10 years = 1.38 vs. 1.10 for men, and RR/10 years = 1.29 vs. 1.02 for women). Living in cities with higher SEI or higher GDP per-capita was associated with a lower risk of poor SRH. GDP per-capita modified the association between age (25-65) and SRH in men and women, with SEI the interaction was less clear. CONCLUSIONS: Across cities in Latin America, aging impact on health is significant among middle-aged adults, and among men. In both genders, cities with lower SEI or lower GDP per-capita were associated with poor SRH. More research is needed to better understand gender inequalities and how city socioeconomic environments, represented by different indicators, modify exposures and vulnerabilities associated with aging.

[Adolescent motherhood in under 100 000 inhabitants communities in the first decades of the millennium]. / Maternidad en la adolescencia en localidades menores de 100 000 habitantes en las primeras décadas del milenio.

OBJECTIVE: To analyze the adolescent motherhood trend and associated factors in under-100 000-inhabitants communities. MATERIALS AND METHODS: Cross-sectional analysis of 16 686 women in under-100 000-inhabitants communities in Encuesta Nacional de Salud y Nutrición (Ensanut) 2006, 2012 and 100k 2018. We adjusted robust Poisson models with adolescent motherhood as dependent variable for women aged 12-19 and 20-24. RESULTS: Attending school and using modern contraceptives decrease adolescent motherhood prevalence in both age groups. Among adolescent girls, having a health financing scheme, and early sexual debut in the case of adults, is positively associated with adolescent motherhood. CONCLUSIONS: It is necessary to strengthen public policies seeking to modify structural factors that provide life choices, and to maintain and strengthen the actions and coverage proposed by Estrategia Nacional para la Prevención del Embarazo en Adolescentes (ENAPEA) targeting this population.

OBJETIVO: Analizar en localidades menores de 100 000 habitantes la tendencia de la maternidad en la adolescencia y factores relacionados. MATERIAL Y MÉTODOS: Análisis transversal de 16 686 mujeres en localidades menores de 100 000 habitantes a partir de la Encuesta Nacional de Salud y Nutrición (Ensanut) 2006, 2012 y 100k 2018. Se ajustaron modelos Poisson robustos con variable dependiente maternidad adolescente para mujeres de 12-19 y 20-24 años. RESULTADOS: Asistir a la escuela y usar anticonceptivos modernos disminuye la prevalencia de maternidad adolescente en ambos grupos de edad. Entre las adolescentes, contar con esquema de financiamiento en salud, y el inicio de vida sexual temprano para el caso de las adultas, se asocia positivamente con maternidad adolescente. CONCLUSIONES: Es necesario fortalecer las políticas públicas para modificar factores estructurales que proporcionen opciones de vida; es preciso mantener y fortalecer las acciones y cobertura propuestas por la Estrategia Nacional para la Prevención del Embarazo en Adolescentes (ENAPEA) focalizándolas en esta población.

Maternidad en la adolescencia en localidades menores de 100 000 habitantes en las primeras décadas del milenio / Adolescent motherhood in under 100 000 inhabitants communities in the first decades of the millennium

Resumen: Objetivo: Analizar en localidades menores de 100 000 habitantes la tendencia de la maternidad en la adolescencia y factores relacionados. Material y métodos: Análisis transversal de 16 686 mujeres en localidades menores de 100 000 habitantes a partir de la Encuesta Nacional de Salud y Nutrición (Ensanut) 2006, 2012 y 100k 2018. Se ajustaron modelos Poisson robustos con variable dependiente maternidad adolescente para mujeres de 12-19 y 20-24 años. Resultados: Asistir a la escuela y usar anticonceptivos modernos disminuye la prevalencia de maternidad adolescente en ambos grupos de edad. Entre las adolescentes, contar con esquema de financiamiento en salud, y el inicio de vida sexual temprano para el caso de las adultas, se asocia positivamente con maternidad adolescente. Conclusiones: Es necesario fortalecer las políticas públicas para modificar factores estructurales que proporcionen opciones de vida; es preciso mantener y fortalecer las acciones y cobertura propuestas por la Estrategia Nacional para la Prevención del Embarazo en Adolescentes (ENAPEA) focalizándolas en esta población.

Abstract: Objective: To analyze the adolescent motherhood trend and associated factors in under-100 000-inhabitants communities. Materials and methods: Cross-sectional analysis of 16 686 women in under-100 000-inhabitants communities inEncuesta Nacional de Salud y Nutrición(Ensanut) 2006, 2012 and 100k 2018. We adjusted robust Poisson models with adolescent motherhood as dependent variable for women aged 12-19 and 20-24. Results: Attending school and using modern contraceptives decrease adolescent motherhood prevalence in both age groups. Among adolescent girls, having a health financing scheme, and early sexual debut in the case of adults, is positively associated with adolescent motherhood. Conclusions: It is necessary to strengthen public policies seeking to modify structural factors that provide life choices, and to maintain and strengthen the actions and coverage proposed byEstrategia Nacional para la Prevención del Embarazo en Adolescentes(ENAPEA) targeting this population.

Poor early childhood outcomes attributable to maternal depression in Mexican women.

We aimed to estimate the population fraction of poor early child health and developmental outcomes attributable to maternal depressive symptoms (DS) contrasting it between low- and middle/high-income households. We used a nationally representative probabilistic sample of 4240 children younger than 5 years old and their mothers, derived from the Mexican National Health and Nutrition Survey Data (ENSANUT 2012). Complex survey design, sampling, and analytic weights were taken into account in analyses. DS was measured by CESD-7. Child outcomes were as follows: breastfeeding, attending well-child check-ups, respiratory disease, diarrhea and general health problems, immunization, accidents, growth, obesity, and food insecurity. Prevalence of DS among mothers was 21.36%. In low-SES households, DS was associated with higher risk of never being breastfed (RR = 1.77; p < .05), health problems (RR = 1.37; p < .05), acute respiratory disease (RR = 1.51; p < .05), accidents requiring child hospitalization (RR = 2.16; p < .01), and moderate or severe food insecurity (RR = 1.58; p < .001). In medium- or high-SES households, DS was associated with higher risk of never attending a developmental check-up (RR = 2.14; p < .05) and moderate or severe food insecurity (RR = 1.75; p < .01). Population risks attributable to DS ranged from 2.30 to 17.45%. Prevention of DS could lead to reduction of problematic early childhood outcomes in both low and medium/high SES.

Bases metodológicas y resultados de la implementación de la Encuesta Nacional de Niños, Niñas y Mujeres en México 2015 / Methodological bases and implementation results of Mexico's National Survey of Children and Women 2015

Resumen: Objetivo: Describir la metodología y los resultados del levantamiento de la Encuesta Nacional de Niños, Niñas y Mujeres en México (ENIM 2015). Material y métodos: La ENIM 2015 es una encuesta probabilística con muestreo polietápico, estratificado y por conglomerados, con representatividad regional, por estratos rural y urbano, y para la población indígena. Se aplicaron cuestionarios para obtener información sobre el hogar, mujeres de 15 a 49 años, niños y niñas menores de cinco años y niños y niñas y adolescentes de 5 a 17 años. Resultados: La tasa de respuesta en hogares y en mujeres fue de 94%; se obtuvo información de 10 760 hogares y 12 110 mujeres; para los niños y niñas y adolescentes y niños y niñas menores de cinco años, estos valores fueron de 98%, 11 607 y 8 066, respectivamente. Conclusión: El diseño probabilístico de la ENIM 2015 permite generar indicadores que se pueden desagregar en cinco regiones, para los estratos rural y urbano y para la población indígena, así como una línea base para 15 indicadores de los ODS.

Abstract: Objective: To describe the methodology and the implementation survey results from National Survey of Children and Women Mexico's (ENIM 2015). Materials and methods: The ENIM 2015 is a probability survey with multistage, stratified and cluster sample, with regional, rural and urban strata, and indigenous population representation.We applied questionnaires to get information from the household, women aged 15 to 49 years, children under five years and children and adolescents aged 5-17 years. Results: The response rate for households and women was 94%, obtaining information from 10 760 households and 12 110 women; while for children and adolescents and children under five years was 98%, 11 607 and 8 066, respectively. Conclusion: The ENIM 2015 probabilistic design allows generate indicators that can be stratified into five regions, rural and urban strata and from indigenous population, as well as a baseline for 15 indicators of the ODS.

[Methodological bases and implementation results of Mexico's National Survey of Children and Women 2015]. / Bases metodológicas y resultados de la implementación de la Encuesta Nacional de Niños, Niñas y Mujeres en México 2015.

OBJECTIVE:: To describe the methodology and the implementation survey results from National Survey of Children and Women Mexico's (ENIM 2015). MATERIALS AND METHODS:: The ENIM 2015 is a probability survey with multistage, stratified and cluster sample, with regional, rural and urban strata, and indigenous population representation.We applied questionnaires to get information from the household, women aged 15 to 49 years, children under five years and children and adolescents aged 5-17 years. RESULTS:: The response rate for households and women was 94%, obtaining information from 10 760 households and 12 110 women; while for children and adolescents and children under five years was 98%, 11 607 and 8 066, respectively. CONCLUSION:: The ENIM 2015 probabilistic design allows generate indicators that can be stratified into five regions, rural and urban strata and from indigenous population, as well as a baseline for 15 indicators of the ODS.