Trends in mortality due to gastrointestinal diseases attributed to alcohol use in Peru from 2003 to 2016.

OBJECTIVE: To assess and identify changes in the temporal trend in mortality from alcohol-attributable gastrointestinal diseases and their disease burden based on years of life lost (YLL) in Peru. MATERIALS AND METHODS: An ecological study of the death records of the Ministry of Health of Peru was conducted from 2003-2016. A gastrointestinal death attributable to alcohol was considered if the basic, intermediate, or final cause of death included ICD-10 codes: K70, K700-4, K709, K292, K852, and K860. Crude and age-adjusted mortality rates were calculated for the general population aged 15 or older and by sex, and YLL. Joinpoint regression analysis was performed to evaluate trends in mortality. RESULTS: There were 11 148 deaths by alcohol-attributable gastrointestinal diseases, being more frequent in males (74.89%), in adults aged 45 years and above (83.67%), living in urban area (69.87%) and the Andes region (60.0%), and in subjects with liver disease (85.98%). Adjusted mortality rates varied from 6.21 (95% CI: 5.78-6.63) in 2003 to 3.95 (95% CI: 3.67-4.22) in 2016. The trend of mortality decreased in the general population (APC: -6.17, 95% CI: -9.9 to -2.2, p=0.007) during the period 2008-2016. Deaths from the causes studied generated 224 545 YLL. CONCLUSIONS: A declining trend was found in gastrointestinal deaths attributable to alcohol in the period 2008-2016. The highest mortality occurred in males, individuals aged 45 years and above, living in urban areas and the Andes region.

Socioeconomic determinants of hypertension and prehypertension in Peru: Evidence from the Peruvian Demographic and Health Survey.

BACKGROUND: Peru is a Latin American country with a significant burden of hypertension that presents worrying rates of disparities in socioeconomic determinants. However, there is a lack of studies exploring the association between those determinants, hypertension and prehypertension in Peruvian population. OBJECTIVE: We aimed to assess the association betwgeen socioeconomic determinants, hypertension and prehypertension using a nationally representative survey of Peruvians. METHODS: We performed a cross-sectional analysis of the Peruvian Demographic and Health Survey (2018), which is a two-staged regional-level representative survey. We used data from 33,336 people aged 15 and older. The dependent variable was blood pressure classification (normal, prehypertension and hypertension) following the Seventh Report of the Joint National Committee (JNC-7) on hypertension management. Independent variables were socioeconomic: age, sex, marital status, wealth index, health insurance, education, region and area of residence. Due to the nature of the dependent variable (more than two categories), we opted to use the multinomial regression model, adjusting the effect of the multistage sample using the svy command. We tested interactions with the adjusted Wald test. RESULTS: The prevalence of prehypertension and hypertension was 33.68% and 19.77%, respectively. Awareness was higher in urban than in rural areas (9.61% vs. 8.31%, p = 0.008). Factors associated with a higher prevalence ratio of both prehypertension and hypertension were age (ratios rose with each age group), male sex (prehypertension aRPR 5.15, 95%CI 4.63-5.73; hypertension aRPR 3.85, 95% CI 3.37-4.40) and abdominal obesity (prehypertension aRPR 2.11, 95%CI 1.92-2.31; hypertension aRPR 3.04, 95% CI 2.69-3.43). Factors with a lower prevalence ratio of both diseases were secondary education (prehypertension aRPR 0.76, 95%CI 0.60-0.95; hypertension aRPR 0.75, 95% CI 0.58-0.97), higher education (prehypertension aRPR 0.78, 95%CI 0.61-0.99; hypertension aRPR 0.62, 95% CI 0.46-0.82), being married/cohabiting (prehypertension aRPR 0.87, 95%CI 0.79-0.95; hypertension aRPR 0.77, 95% CI 0.68-0.87), richest wealth index (only prehypertension aRPR 0.76, 95%CI 0.63-0.92) and living in cities different to Lima (rest of the Coastline, Highlands and Jungle). Having health insurance (only hypertension aRPR 1.26, 95%CI 1.03-1.53) and current drinking (only prehypertension aRPR 1.15, 95%CI 1.01-1.32) became significant factors in rural areas. CONCLUSIONS: We evidenced socioeconomic disparities among people with hypertension and prehypertension. Better health policies on reducing the burden of risk factors are needed, besides, policy decision makers should focus on hypertension preventive strategies in Peru.

Alcohol consumption and suicide risk in medical internship: A Peruvian multicentric study.

INTRODUCTION AND AIM: Suicide and harmful alcohol consumption are major health problems, especially in medical students. This study aimed to evaluate the association between risk for alcohol abuse and suicide risk in medical interns of Peruvian hospitals. DESIGN AND METHODS: We conducted a multicentre cross-sectional study in medical interns from 18 Peruvian hospitals. We measured suicide risk, risk for alcohol abuse, depression and self-esteem using the Plutchik Suicide Risk Scale, CAGE, Zung Self-Rating Depression Scale and Rosenberg Self-Esteem Scale, respectively. We used χ2 and Student t-tests for descriptive analysis. To evaluate the association between risk for alcohol abuse and suicide risk we generated crude and adjusted Poisson regression models with robust variance and estimated prevalence ratios with 95% confidence intervals. RESULTS: We surveyed 433 medical interns. The prevalence of suicide risk and risk for alcohol abuse was 19.6% and 27.5%, respectively. We found significant differences in suicide risk according to age (P < 0.001), region of origin (P = 0.002), with whom the participant lived (P < 0.001), university of origin (P = 0.040), type of hospital (P = 0.042), family history of attempted suicide (P = 0.043), self-esteem level (P < 0.001) and alcohol consumption (P < 0.001). In the adjusted model, age (PRa: 1.11, 95% confidence interval 1.05-1.17) and risk for alcohol abuse (PRa: 7.60, 95% confidence interval 4.46-12, 96) were associated with suicide risk. DISCUSSION AND CONCLUSIONS: Two out of 10 medical interns had a positive screening for suicide risk. Age and especially risk for alcohol abuse were the associated variables.

Is anemia a public health problem among children under five years ago in Peru? Findings from a national healthcare administrative database (2012 and 2016) using Geographic Information Systems / ¿Es la anemia un problema de salud pública entre los menores de cinco años en el Perú? Análisis de una base de datos administrativa nacional de salud (2012 y 2016) empleando Sistemas de Información Geográfica

The objective of this study was to assess the change in the prevalence of anemia among under-five children attending public health services in Peru between 2012 and 2016, according to their place of residence, and to identify spatial clusters of districts with a high prevalence of anemia. An analytical cross-sectional study was carried out, based on data from the Nutritional State Information System from 2012 and 2016. We calculated the spatial autocorrelation of anemia prevalence at the district level using a global and local Moran's I index. The prevalence of anemia was 34.4% (2012) and 40.3% (2016). In 2012 and 2016, 41.7% and 46.5% of districts, respectively, had a prevalence of anemia considered a severe public health problem acording WHO criteria. Positive spatial autocorrelation was found between the prevalence of anemia and the districts for both years (2012 Moran's I: 0.22; 2016: 0.31, both p <0.001). Of the total number of districts, 8.3% (2012) and 12.6% (2016) presented a high prevalence of anemia and were also surrounded by districts with high prevalence. Anemia is a public health problem among children under five in Peru attending public health services and we identified areas with a higher concentration of anemia prevalence. Spatial patterns of anemia should be considered in the development and implementation of health interventions.

El objetivo del estudio fue evaluar la prevalencia de anemia en menores de cinco anos atendidos en servidos de salud públicos en Perú entre 2012-2016 e identificar conglomerados espaciales de distritos de alta prevalencia de anemia. Se realizó un estudio analítico de corte transversal, basado en los datos del Sistema de Información dei Estado Nutricional del Perú 2012 y 2016. La autocorrelación espacial de la prevalencia de anemia a nivel distrital se calculó utilizando el índice I de Moran global y local. Se encontro una prevalencia de anemia del 34.4% (2012) y 40.3% (2016), con41.7% (2012) y 46.5% (2016) de distritos con prevalencias de anemia consideradas como grave problema de salud pública según clasificación OMS. Se encontró una autocorrelación espacial positiva entre la prevalencia de anemia y los distritos (Moran's I 2012: 0.22; 2016: 0.31, ambos p <0.001), donde 8.3% (2012) y 12.6% (2016) de distritos con alta prevalencia se encontraban rodeados por distritos con alta prevalencia. La anemia es un problema de salud pública en menores de cinco años en el Perú atendidos en servicios de salud públicos. Existen áreas con mayor concentración de prevalencia de anemia. Los patrones espaciales de anemia deben considerarse en el desarrollo y la implementación de intervenciones de salud.