Inequidad de ingreso y autopercepción de salud: un análisis desde la perspectiva contextual en las comunas chilenas / Income inequality and self rated health in Chile

Background: The correlation between income inequality and life expectancy was demonstrated 10 years ago, but later, several studies suggested that the negative impact of a low economic income on the health status was disappearing. Aim: To assess the independent effects of community income inequality on self rated health in Chile. Material and methods : Multilevel analysis of the 2000 National Socio Economic Characterization Survey (CASEN) data from Chile. Individual level information included self rated health, age, sex, ethnicity, marital status, education, income, type of health insurance and residential setting (urban/rural). Community level variables included the Gini coefficient and median income. The main outcome measure was dichotomized self rated health (0 if excellent, very good or good; 1 if fair or poor). Results: 101,374 individuals (at level 1) aged 18 and above, nested within 285 communities (at level 2) and 13 regions (at level 3) were studied. Controlling for a range of individual level predictors, a significant gradient was observed between income and poor self rated health, with very poor most likely to report poor health (10.5 percent) followed by poor (9.5 percent) low (9 percent) middle (7 percent), high (6 percent) and very high (4.5 percent) income earners. Controlling for individual and community effects of income, a significant non linear effect of community income inequality was observed, with the most unequal communities being associated with approximately 5 percent higher likelihood of reporting poor health compared to the most equal communities. Conclusions : Individual income does not explain any of the between community differences and neither does it wash the significant effects of income inequality on poor self rated health. The contextual effect of inequality is almost as large as the differential observed in poor health comparing the very poor to the very rich individual income categories

Actividad plasmática de la enzima convertidora de angiotensina I en población chilena normal y relación con el genotipo inserción/deleción de la enzima convertidora de angiotensina / Plasma activity of angiotensin I converting enzyme in a normal chilean population and it relation to de I/D polymorphism

El objetivo del estudio fue estimar la prevalencia de los distintos alelos del polimorfismo del gen de la enzima convertidora de angiotensina (ECA), inserción/deleción (I/D) y simultáneamente la actividad de ECA plasmática (pl) asociada en población sana chilena normotensa. 117 sujetos sanos normotensos (entre 45 y 60 años, de nivel socioeconómico medio, no obesos ni diabéticos) fueron seleccionados de un estudio poblacional sobre prevalencia de factores de riesgo de enfermedades crónicas. Las frecuencias de los alelos I y D fueron 0,57 y 0,43 respectivamente. La actividad de ECApl fue en promedio 15,3ñ3,9 U/mL. Comparado con sujetos con genotipo II, la actividad de ECApl fue significativamente mayor en sujetos con genotipo ID y DD sin diferencias entre ellos. No se observó correlación entre actividad de ECApl y masa VI en ningún sexo ni en los distintos genotipos. El análisis de regresión lineal multivariado (que usó masa VI e índice de masa VI como variables dependientes mostró efectos independientes (p<0,05) del sexo (mayor masa VI en varones) y de la presión diastólica, pero no del genotipo DD. En conclusión, en esta población la presencia del alelo D del gen de la ECA determina mayor actividad de ECA circulante, lo cual podría estar asociado a mayor morbilidad cardiovascular. En esta población sana normotensa, el sexo masculino y la presión diastólica, pero no la presencia del alelo D, están asociados a mayor masa VI

Hábitos alimentarios de la población de Valparaíso: encuesta de base CARMEN conjunto de acciones para la reducción multifactorial de las enfermedades no transmisibles / Eating habits of the population from Valparaíso: CARMEN base survey actions for the multifactorial reduction of noncommunicable chronic diseases

Las enfermedades crónicas no transmisibles (ECNT) han tenido un aumento progresivo durante en las últimas décadas en nuestro país, ocupando los primeros lugares como causas de morbilidad y mortalidad de los adultos. Estas causas se pueden modificar si intervenimos sobre los factores de riesgo que predicen o anticipan el daño. Dentro de los factores de riesgo de la población, la alimentación tiene una preponderancia como un vehículo de prevención. Sin embargo, no existen cifras claras del consumo de alimentos a escala nacional, contando sólo con algunos datos parciales derivados de trabajos de investigación. El proyecto CARMEN (conjunto de acciones para la reducción multifactorial de las enfermedades no transmisibles), tuvo por objeto medir los factores de riesgo y hábitos conductuales de una población representativa de la comuna de Valparaíso. El estudio se efectúo a una muestra de 3120 sujetos (1020 hombres y 2100 mujeres) entre 25 y 64 años. Más del 94 por ciento de la población consumía aceite como su principal fuente de grasa, un 71,7 por ciento de los hombres y un 63,7 por ciento de las mujeres indica no consumir leche y un 98 por ciento de los encuestados consume pan diariamente. Se discute la relación de los hábitos alimentarios con las ECNT

Factores de riesgo para las enfermedades no transmisibles: metodología y resultados globales de la encuesta de base del programa CARMEN: conjunto de acciones para la reducción multifactorial de las enfermedades no transmisibles / Risk factors for chronic non communicable diseases: methods and results of CARMEN program basal survey

Background: In the last decades, chronic non communicable diseases are becoming the main cause of disability and mortality among adults. The risk factor surveillance and management is the most efficient mean of reducing the impact of these diseases. Aim: To report the results of a non communicable disease risk factor surveillance program in Valparaiso, Chile. Material and methods: a random samples of people aged 25 to 64 years old living in Valparaiso, Chile was studied. Subjects were questioned about smoking and physical activity habits. Blood pressure, height and weight were measured using standardized techniques at their homes and blood samples were obtained to measure serum lipid levels and oral glucose tolerance test at the nearest outpatient clinic. Results: Of the initial 3852 homes selected, 752 individuals did no agree to answer the inquiry, therefore 3120 subjects were finally interviewed. Of these, 40.6 percent were smokers, 15 percent drank alcohol in two or more occasions per month, 84.6 percent were physically inactive, 19.7 percent had a body mass index over 30 kg/m2, 11.1 percent had high blood pressure, 3.9 percent were diabetic and 46.9 percent had high serum cholesterol levels. Conclusions: The basal survey for the CARMEN program shows a high prevalence of cardiovascular risk factors among chileans

Prevalencia de hipertensión arterial en Valparaíso: resultados de la encuesta de base el programa CARMEN: conjunto de acciones para la reducción multifactorial de las enfermedades no transmisibles / Prevalence of hypertension in Valparaíso: results of the base survey of CARMEN program

Background: There is little information about the real prevalence of hypertension in Chile. Aim: To assess the adjusted prevalence of hypertension and its main therapeutic measures among adults living in Valparaiso, Chile. Material and methods: A random sample of dwellings in Valparaiso was chosen. Among these, an individual of 25 to 64 years old was randomly surveyed for risk factors for chronic diseases and sociodemographic parameters. Blood pressure, weight, height, oral glucose tolerance test, fasting cholesterol and triglycerides were also measured. Prevalence was pondered according to age, sex, and probability of selection in the dwelling interior. Results: Three thousand one hundred twelve individuals were studied. The adjusted prevalence of hypertension was 11.4 percent (11.6 percent among females and 10.6 percent among men). The prevalence increased along with age from 3 and 1.9 percent in men and women of 25 to 34 years old respectively, to 18.2 and 27.4 percent among men and women of 55 to 64 years old (p< 0.01). People of low socioeconomic level had a higher prevalence of hypertension than those of high socioeconomic level (14.2 and 9.3 percent respectively, p < 0.05). Diabetes, obesity and hypercholesterolemia were significantly more frequent in subjects with hypertension than in the general population. Forty four percent of diagnosed hypertensives were receiving medications (angiotensin converting enzyme inhibitors 40 percent, calcium antagonists 34 percent, beta blockers 22 percent). Twenty five percent of patients were treated with a combination of medications. Of those treated, only 22 percent had normal blood pressure levels at the moment of examination. Conclusions: High blood pressure is an important public health problem that requires more efficient detection and treatment programs