RESUMO
Health inequalities are marked in Chile. To address this situation, a health reform was implemented in 2005 that guarantees acute myocardial infarction (AMI) health care for the entire population. We evaluated if the health reform changed AMI early and long-term survival rates by hospital provider (public/private) using a longitudinal population-based study of patients ≥15 years with a first AMI in Chile between 2002 and 2011. Time trends and early (within 28 days) and long-term (29-365 days) survival by age were assessed. We identified 59,557 patients: median age of 64 years; 68.9% men; 83.2% treated at public hospitals; 74.4% with public insurance. Early and long-term case-fatality was higher at public hospitals (14.6% vs 9.3%; P < .001 and 5.8% vs 3.3%; P < .001, respectively). There was a higher annual increase for early and long-term survival in public hospitals, 0.008 percentage points (95% CI: 0.006, 0.009; P < .0001) and 0.03 (0.002, 0.003; P < .0001), than in private hospitals, 0.0002 (95% CI: -0.0001, 0.005; P = .10) and 0.002 (95% CI: 0.0007, 0.003; P = .004), respectively. Being served at public hospitals affected early and long-term survival, especially in patients <70 years: hazard ratio was 2.01 (95% CI: 1.77, 2.28) and 3.11 (2.41, 4.01), respectively. Therefore, even if inequalities persist, there was a higher increase in early and long-term survival in public versus private hospitals.
Assuntos
Reforma dos Serviços de Saúde/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Infarto do Miocárdio/mortalidade , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Chile/epidemiologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Distribuição por SexoRESUMO
BACKGROUND: A low socioeconomic status is associated with higher overall mortality rates. AIM: To assess the effect of socioeconomic inequalities on survival of patients hospitalized with a first myocardial infarction. MATERIAL AND METHODS: Analysis of hospital discharge and mortality databases of the Ministry of Health. Patients aged over 15 years discharged between 2002 and 2011 with a first myocardial infarction (code I-21, ICD-10) were identified. Their survival was verified with the mortality registry. Survival from 0 to 28 and from 29 to 365 days was analyzed. Socioeconomic status was determined using the type of health insurance, stratified as public insurance (low and medium status) and private insurance (high status). Prais-Winsten trend (P-W) and Cox survival analyses were done. RESULTS: We analyzed 59,557 patients (69% males). Sixty three percent were of low socioeconomic status, 19% medium and 18% high. Between 2002 and 2011 the increase in survival was higher among patients of low socioeconomic status, mainly in women (P-W coefficients 0.58:0.31-0.86 in men and 1.12:0.84-1.41 in women for 0-28 days survival and 0.24:0.09-0.39 in men and 0.48:0.37-0.60 in women for 29-365 days survival, respectively). However, age and year of hospitalization adjusted analysis showed a higher mortality risk among patients of low socioeconomic status at 0-28 days (HR 1.67:1.53-1.83 for men and 1.49:1.34-1.66 for women) and at 29-365 days (HR 2.30:1.75-2.71 for men and 1.90:1.56-1.85 for women). CONCLUSIONS: Survival after a myocardial infarction improved in the last decade especially in patients of low socioeconomic status. However, subjects of this stratum continue to have a higher mortality.
Assuntos
Infarto do Miocárdio/mortalidade , Classe Social , Adulto , Idoso , Chile/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Taxa de SobrevidaRESUMO
Background: A low socioeconomic status is associated with higher overall mortality rates. Aim: To assess the effect of socioeconomic inequalities on survival of patients hospitalized with a first myocardial infarction. Material and Methods: Analysis of hospital discharge and mortality databases of the Ministry of Health. Patients aged over 15 years discharged between 2002 and 2011 with a first myocardial infarction (code I-21, ICD-10) were identified. Their survival was verified with the mortality registry. Survival from 0 to 28 and from 29 to 365 days was analyzed. Socioeconomic status was determined using the type of health insurance, stratified as public insurance (low and medium status) and private insurance (high status). Prais-Winsten trend (P-W) and Cox survival analyses were done. Results: We analyzed 59,557 patients (69% males). Sixty three percent were of low socioeconomic status, 19% medium and 18% high. Between 2002 and 2011 the increase in survival was higher among patients of low socioeconomic status, mainly in women (P-W coefficients 0.58:0.31-0.86 in men and 1.12:0.84-1.41 in women for 0-28 days survival and 0.24:0.09-0.39 in men and 0.48:0.37-0.60 in women for 29-365 days survival, respectively). However, age and year of hospitalization adjusted analysis showed a higher mortality risk among patients of low socioeconomic status at 0-28 days (HR 1.67:1.53-1.83 for men and 1.49:1.34-1.66 for women) and at 29-365 days (HR 2.30:1.75-2.71 for men and 1.90:1.56-1.85 for women). Conclusions: Survival after a myocardial infarction improved in the last decade especially in patients of low socioeconomic status. However, subjects of this stratum continue to have a higher mortality.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Classe Social , Infarto do Miocárdio/mortalidade , Chile/epidemiologia , Taxa de Sobrevida , Estudos Longitudinais , Distribuição por SexoRESUMO
OBJECTIVES: We estimated the roles of childhood socioeconomic position (ChSEP) and education attainment on chronic diseases in Chilean adults, mediated through structural determinants and health behaviors, to identify potential pro-equity interventions. METHODS: We analyzed Chile's longitudinal Social Protection Surveys, a national sample of 14,788 adults with follow-up to 2009. Controlled direct effects (CDE) and natural effects (NDE and NIE) of ChSEP and education on number of chronic diseases were estimated with negative binomial models. RESULTS: CDE of low ChSEP with education fixed at 12 years showed a 12% increase with 4% indirect effects. CDEs at favorable levels of BMI, smoking, alcohol use, and physical activity were similar. CDE estimates for education adjusted for ChSEP were larger with negligible mediation. CDEs for women were generally larger. CONCLUSIONS: Low ChSEP exerts a primarily direct effect on later chronic disease, modestly mediated by education. Education attainment showed larger direct effects with minimal mediation by behaviors. Strengthening current-early child development and education policies, particularly gender aspects, may reduce social inequalities and key pathways for reducing chronic disease inequalities in Chile.
Assuntos
Doença Crônica/epidemiologia , Escolaridade , Disparidades nos Níveis de Saúde , Classe Social , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Chile/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
OBJECTIVE: To estimate the association between the intake of sugar-sweetened non-alcoholic beverages and body mass index (BMI) in Chilean school children. MATERIALS AND METHODS: Food consumption frequency data were analyzed for school children aged 6 to 18. The association between consumption of sugar-sweetened beverages and BMI was estimated by multivariate lineal regression models. RESULTS: Sugar-sweetened beverages are consumed on a daily basis by 92% (95%CI:90-94) of subjects with daily intake medians of 424 mL (p25-p75:212-707). Every extra daily portion of sugar-sweetened beverages consumed by school children aged 6 to 13 is associated with 0.13 BMI z-scores (95%CI:0.04-0.2;p=0.01). CONCLUSIONS: School children consume sugar-sweetened beverages daily with intake medians close to 0.5L. There is an association between sugar-sweetened beverage consumption and higher BMI in Chilean school children.
Assuntos
Bebidas/estatística & dados numéricos , Índice de Massa Corporal , Sacarose Alimentar , Obesidade Infantil/epidemiologia , Adolescente , Comportamento do Adolescente , Criança , Comportamento Infantil , Chile/epidemiologia , Feminino , Humanos , Masculino , Sobrepeso/epidemiologia , Estudos de Amostragem , Fatores SocioeconômicosRESUMO
Objetivo. Estimar la asociación entre la ingesta de bebidas azucaradas analcohólicas y el índice de masa corporal (IMC) en escolares chilenos. Material y métodos. Se analizaron datos de frecuencia de consumo de alimentos en escolares de entre 6 y 18 años de edad. Se estimó la asociación entre el consumo de bebidas azucaradas y el IMC a través de modelos de regresión lineal multivariada. Resultados. El 92% (IC95%:90-94) consume bebidas azucaradas diariamente, con medianas de ingesta de 424 ml (p25-p75:212-707). En los escolares de 6 a 13 años, cada incremento de una porción diaria de gaseosas y refrescos con azúcar se asocia con 0.13 puntajes z más de IMC (IC95%:0.04-0.2;p=0.01). Conclusiones. El consumo de bebidas azucaradas en escolares chilenos es diario y alcanza medianas de ingesta cercanas a medio litro. Existe asociación entre el consumo de bebidas azucaradas y mayor IMC.
Objective. To estimate the association between the intake of sugar-sweetened non-alcoholic beverages and body mass index (BMI) in Chilean school children. Materials and methods. Food consumption frequency data were analyzed for school children aged 6 to 18. The association between consumption of sugar-sweetened beverages and BMI was estimated by multivariate lineal regression models. Results. Sugar-sweetened beverages are consumed on a daily basis by 92% (95%CI:90-94) of subjects with daily intake medians of 424 mL (p25-p75:212-707). Every extra daily portion of sugar-sweetened beverages consumed by school children aged 6 to 13 is associated with 0.13 BMI z-scores (95%CI:0.04-0.2;p=0.01). Conclusions. School children consume sugar-sweetened beverages daily with intake medians close to 0.5L. There is an association between sugar-sweetened beverage consumption and higher BMI in Chilean school children.