RESUMO
Abstract Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in developed countries. Although cigarette smoking is the major risk factor, only 10-20% of smokers develop COPD. The extent of cigarette smoking (pack-years and smoking duration) accounts for only 15% of the variation in lung function, indicating that differences in susceptibility to COPD must exist. We provide an overview of the complexity of nicotine addiction and COPD, with special attention to the involvement of genetic factors. The following aspects are discussed in the present article: (1) epidemiology in Mexico and (2) a review of the published literature on genetic association studies using the National Center for Biotechnology Information database of the United States as a search tool. COPD is unique among complex genetic diseases where an environmental risk factor is known and the level of exposure can be documented with some precision. The high morbidity and mortality associated with COPD and its chronic and progressive nature has prompted the use of molecular genetic studies to identify susceptibility factors for the disease. Biomedical research has a remarkable set of tools to aid in the discovery of genes and polymorphisms. We present a review of the most relevant genetic associations in nicotine addiction and COPD.
Assuntos
Humanos , Tabagismo/genética , Predisposição Genética para Doença , Doença Pulmonar Obstrutiva Crônica/genética , Tabagismo/complicações , Tabagismo/epidemiologia , Fumar/efeitos adversos , Fumar/genética , Fumar/epidemiologia , Fatores de Risco , Progressão da Doença , Doença Pulmonar Obstrutiva Crônica/etiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , México/epidemiologia , Nicotina/administração & dosagem , Nicotina/efeitos adversosRESUMO
A medida que las agendas contemporáneas más relevantes de la salud pública mundial y regional se van alineando en sus componentes conceptuales y emerge más explícitamente el rol medular de la equidad como su principio constitutivo, va creciendo también el reconocimiento del valor estratégico del monitoreo de desigualdades sociales en salud como el instrumento por excelencia de la inteligencia sanitaria para juzgar objetivamente el progreso hacia la equidad en salud, pero también para dar cuenta de la acción sobre los determinantes sociales de la salud, el avance hacia el alcance progresivo de la universalidad en salud y el éxito de iniciativas intersectoriales con enfoque de salud en todas las políticas. Estas transformaciones acontecen en el marco de una cada vez más evidente transición paradigmática de la salud pública. Este ensayo plantea cuatro consideraciones axiológicas inherentes a-y esenciales para-la conceptualization e instrumentación de la medición y monitoreo de las desigualdades en salud: la ecoepidemiología como era emergente en la salud pública contemporánea, los determinantes de la salud como modelo de causalidad y núcleo del nuevo enfoque paradigmático, la relación entre jerarquía social y salud para entender el gradiente en salud, y la necesidad práctica de una clasificación socioeconómica para capturar la dimensión social de la determinación de la salud. Se plantea que estas cuatro cuestiones valorativas otorgan coherencia y racionalidad epidemiológicas al proceso de medición y monitoreo de las desigualdades en la salud y, por extensión, a la formulación de propuestas de política sanitaria en pro de la equidad.
As the conceptual components of the most important contemporary public health agendas at the global and regional levels are brought into alignment and as it becomes more clearly understood that equity is a constitutive principle of these agendas, there is also a growing awareness of the strategic value of monitoring social inequalities in health. This is the health intelligence tool par excellence, not only for objectively assessing progress towards achieving health equity, but also for reporting action on the social determinants of health, progress towards the attainment of health for all, and the success of intersectoral efforts that take a "health in all policies" approach. These transformations are taking place in the context of an increasingly evident paradigm shift in public health. This essay presents four axiological considerations inherent to-and essential for -conceptualizing and implementing ways to measure and monitor health inequalities: ecoepidemiology as an emerging field in contemporary public health; the determinants of health as the causal model and core of the new paradigm; the relationship between the social hierarchy and health to understand the health gradient; and the practical need for a socioeconomic classification system that captures the social dimension in the determinants of health. The essay argues that these four axiological considerations lend epidemiologic coherence and rationality to the process of measuring and monitoring health inequalities and, by extension, to the development of pro-equity health policy proposals.