Differences in the Prevalence of Non-Communicable Disease between Slum Dwellers and the General Population in a Large Urban Area in Brazil.

Residents of urban slums are at greater risk for disease than their non-slum dwelling urban counterparts. We sought to contrast the prevalences of selected non-communicable diseases (NCDs) between Brazilian adults living in a slum and the general population of the same city, by comparing the age and sex-standardized prevalences of selected NCDs from a 2010 survey in Pau da Lima, Salvador Brazil, with a 2010 national population-based telephone survey. NCD prevalences in both populations were similar for hypertension (23.6% (95% CI 20.9⁻26.4) and 22.9% (21.2⁻24.6), respectively) and for dyslipidemia (22.7% (19.8⁻25.5) and 21.5% (19.7⁻23.4)). Slum residents had higher prevalences of diabetes mellitus (10.1% (7.9⁻12.3)) and of overweight/obesity (46.5% (43.1⁻49.9)), compared to 5.2% (4.2⁻6.1) and 40.6% (38.5⁻42.8) of the general population in Salvador. Fourteen percent (14.5% (12.1⁻17.0)) of slum residents smoked cigarettes compared to 8.3% (7.1⁻9.5) of the general population in Salvador. The national telephone survey underestimated the prevalence of diabetes mellitus, overweight/obesity, and smoking in the slum population, likely in part due to differential sampling inside and outside of slums. Further research and targeted policies are needed to mitigate these inequalities, which could have significant economic and social impacts on slum residents and their communities

Cardiovascular Disease and Health Care System Impact on Functionality and Productivity in Argentina: A Secondary Analysis

Objectives: To examine the impact of cardiovascular disease (CVD) events on patient functionality and productivity on the basis of patient use of public or social/private institution health care. Methods: A secondary analysis was conducted of data drawn from records of Argentinian patients, 3 to 15 months posthospitalization after a CVD event, who had originally participated in a multicountry, cross-sectional study assessing the microeconomic impact of a CVD event. Respondents were stratified according to their use of health care institution (public or social/private). Among these groups, pre- and post-CVD event changes in functionality and productivity were compared. Results: Participants' (N = 431) mean age was 56.5 years, and 73.5% were men. Public sector patients reported significantly higher rates of decline in ability to perform moderate activities (P < 0.05), a greater decrease in time spent at work (P < 0.01), a greater limit in the type of work-related activities (P < 0.01), and a higher rate of emotional problems (P < 0.01). Having health insurance (private or social) (odds ratio [OR] = 0.55; 95% confidence interval [CI] 0.35-0.85; P < 0.01) and a higher income (OR = 0.99; 95% CI 0.99-0.99; P < 0.01) were inversely and significantly associated with loss of productivity. Cerebrovascular disease (OR = 2.55; 95% CI 1.42-4.60; P < 0.01) was also significantly associated with productivity loss. Conclusions: In Argentina, patients receiving care in the public sector experienced a greater impact on functionality and productivity after their hospitalization for a CVD event. Lack of insurance, low income, and cerebrovascular disease event were the major determinants of productivity loss. Further investigation is needed to better understand contributors to these differences.Fil: Calcagno, Juan I.. Fogarty International Clinical Research Scholars Program; Estados Unidos. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Iribarren, Sarah J.. Instituto de Efectividad Clínica y Sanitaria; Argentina. Fogarty International Clinical Research Scholars Program; Estados Unidos. Columbia University; Estados UnidosFil: Caporale, Joaquín E.. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Pearce, Patricia F.. Loyola University; Estados UnidosFil: Prabhakaran, Dorairaj. Centre For Chronic Disease Control; IndiaFil: Pichón-Riviere, Andrés. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentin

Global morbidity and mortality of Leptospirosis: a systematic review

Background Leptospirosis, a spirochaetal zoonosis, occurs in diverse epidemiological settings and affects vulnerable populations, such as rural subsistence farmers and urban slum dwellers. Although leptospirosis is a life-threatening disease and recognized as an important cause of pulmonary haemorrhage syndrome, the lack of global estimates for morbidity and mortality has contributed to its neglected disease status. Methodology/Principal Findings We conducted a systematic review of published morbidity and mortality studies and databases to extract information on disease incidence and case fatality ratios. Linear regression and Monte Carlo modelling were used to obtain age and gender-adjusted estimates of disease morbidity for countries and Global Burden of Disease (GBD) and WHO regions. We estimated mortality using models that incorporated age and gender-adjusted disease morbidity and case fatality ratios. The review identified 80 studies on disease incidence from 34 countries that met quality criteria. In certain regions, such as Africa, few quality assured studies were identified. The regression model, which incorporated country-specific variables of population structure, life expectancy at birth, distance from the equator, tropical island, and urbanization, accounted for a significant proportion (R2 = 0.60) of the variation in observed disease incidence. We estimate that there were annually 1.03 million cases (95% CI 434,000–1,750,000) and 58,900 deaths (95% CI 23,800–95,900) due to leptospirosis worldwide. A large proportion of cases (48%, 95% CI 40–61%) and deaths (42%, 95% CI 34–53%) were estimated to occur in adult males with age of 20–49 years. Highest estimates of disease morbidity and mortality were observed in GBD regions of South and Southeast Asia, Oceania, Caribbean, Andean, Central, and Tropical Latin America, and East Sub-Saharan Africa. Conclusions/Significance Leptospirosis is among the leading zoonotic causes of morbidity worldwide and accounts for numbers of deaths, which approach or exceed those for other causes of haemorrhagic fever. Highest morbidity and mortality were estimated to occur in resource-poor countries, which include regions where the burden of leptospirosis has been underappreciated

Differences in the Prevalence of Non-Communicable Disease between Slum Dwellers and the General Population in a Large Urban Area in Brazil

Residents of urban slums are at greater risk for disease than their non-slum dwelling urban counterparts. We sought to contrast the prevalences of selected non-communicable diseases (NCDs) between Brazilian adults living in a slum and the general population of the same city, by comparing the age and sex-standardized prevalences of selected NCDs from a 2010 survey in Pau da Lima, Salvador Brazil, with a 2010 national population-based telephone survey. NCD prevalences in both populations were similar for hypertension (23.6% (95% CI 20.9–26.4) and 22.9% (21.2–24.6), respectively) and for dyslipidemia (22.7% (19.8–25.5) and 21.5% (19.7–23.4)). Slum residents had higher prevalences of diabetes mellitus (10.1% (7.9–12.3)) and of overweight/obesity (46.5% (43.1–49.9)), compared to 5.2% (4.2–6.1) and 40.6% (38.5–42.8) of the general population in Salvador. Fourteen percent (14.5% (12.1–17.0)) of slum residents smoked cigarettes compared to 8.3% (7.1–9.5) of the general population in Salvador. The national telephone survey underestimated the prevalence of diabetes mellitus, overweight/obesity, and smoking in the slum population, likely in part due to differential sampling inside and outside of slums. Further research and targeted policies are needed to mitigate these inequalities, which could have significant economic and social impacts on slum residents and their communities

Differences in the Prevalence of Non-Communicable Disease between Slum Dwellers and the General Population in a Large Urban Area in Brazil

Residents of urban slums are at greater risk for disease than their non-slum dwelling urban counterparts. We sought to contrast the prevalences of selected non-communicable diseases (NCDs) between Brazilian adults living in a slum and the general population of the same city, by comparing the age and sex-standardized prevalences of selected NCDs from a 2010 survey in Pau da Lima, Salvador Brazil, with a 2010 national population-based telephone survey. NCD prevalences in both populations were similar for hypertension (23.6% (95% CI 20.9–26.4) and 22.9% (21.2–24.6), respectively) and for dyslipidemia (22.7% (19.8–25.5) and 21.5% (19.7–23.4)). Slum residents had higher prevalences of diabetes mellitus (10.1% (7.9–12.3)) and of overweight/obesity (46.5% (43.1–49.9)), compared to 5.2% (4.2–6.1) and 40.6% (38.5–42.8) of the general population in Salvador. Fourteen percent (14.5% (12.1–17.0)) of slum residents smoked cigarettes compared to 8.3% (7.1–9.5) of the general population in Salvador. The national telephone survey underestimated the prevalence of diabetes mellitus, overweight/obesity, and smoking in the slum population, likely in part due to differential sampling inside and outside of slums. Further research and targeted policies are needed to mitigate these inequalities, which could have significant economic and social impacts on slum residents and their communities

Global burden of leptospirosis: estimated in terms of disability adjusted life years

BACKGROUND: Leptospirosis, a spirochaetal zoonosis, occurs in diverse epidemiological settings and affects vulnerable populations, such as rural subsistence farmers and urban slum dwellers. Although leptospirosis can cause life-threatening disease, there is no global burden of disease estimate in terms of Disability Adjusted Life Years (DALYs) available. METHODOLOGY/PRINCIPAL FINDINGS: We utilised the results of a parallel publication that reported global estimates of morbidity and mortality due to leptospirosis. We estimated Years of Life Lost (YLLs) from age and gender stratified mortality rates. Years of Life with Disability (YLDs) were developed from a simple disease model indicating likely sequelae. DALYs were estimated from the sum of YLLs and YLDs. The study suggested that globally approximately 2·90 million DALYs are lost per annum (UIs 1·25-4·54 million) from the approximately annual 1·03 million cases reported previously. Males are predominantly affected with an estimated 2·33 million DALYs (UIs 0·98-3·69) or approximately 80% of the total burden. For comparison, this is over 70% of the global burden of cholera estimated by GBD 2010. Tropical regions of South and South-east Asia, Western Pacific, Central and South America, and Africa had the highest estimated leptospirosis disease burden. CONCLUSIONS/SIGNIFICANCE: Leptospirosis imparts a significant health burden worldwide, which approach or exceed those encountered for a number of other zoonotic and neglected tropical diseases. The study findings indicate that highest burden estimates occur in resource-poor tropical countries, which include regions of Africa where the burden of leptospirosis has been under-appreciated and possibly misallocated to other febrile illnesses such as malaria

Differences in the Prevalence of Non-Communicable Disease between Slum Dwellers and the General Population in a Large Urban Area in Brazil

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2018-04-24T13:49:51Z No. of bitstreams: 1 Snyder R E Differences in the Prevalence....pdf: 1041289 bytes, checksum: f90cc066f12b732cbb73d1ffa1a551a6 (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2018-04-24T14:02:44Z (GMT) No. of bitstreams: 1 Snyder R E Differences in the Prevalence....pdf: 1041289 bytes, checksum: f90cc066f12b732cbb73d1ffa1a551a6 (MD5)Made available in DSpace on 2018-04-24T14:02:44Z (GMT). No. of bitstreams: 1 Snyder R E Differences in the Prevalence....pdf: 1041289 bytes, checksum: f90cc066f12b732cbb73d1ffa1a551a6 (MD5) Previous issue date: 2017Oswaldo Cruz Foundation, Brazilian Ministry of Health; the Coordination for the Improvement of Higher Education Personnel (CAPES), Brazilian Ministry of Education; the National Counsel of Technological and Scientific Development (CNPq); the National Institutes of Health (NIH) (grants R01 AI052473, U01 AI088752, R01 TW009504, R24 TW007988, R25 TW009338, and D43 TW00919 to A.I.K.).University of California. Division of Epidemiology. Berkeley, CA, USAUniversity of California. Department of Medicine. San Francisco, CA, USAFundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, BrasilFundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, BrasilFundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, BrasilFederal University of Bahia. Faculty of Pharmacy. Salvador, BA, Brasil / Federal University of Bahia. School of Medicine. Salvador, BA, BrasilUniversity of California. Division of Infectious Diseases and Vaccinology. Berkeley, CA, USAFundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Federal University of Bahia. School of Medicine. Salvador, BA, BrasilFundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Yale University School of Public Health. Department of the Epidemiology of Microbial Diseases. New Haven, CT, USAFundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, BrasilResidents of urban slums are at greater risk for disease than their non-slum dwelling urban counterparts. We sought to contrast the prevalences of selected non-communicable diseases (NCDs) between Brazilian adults living in a slum and the general population of the same city, by comparing the age and sex-standardized prevalences of selected NCDs from a 2010 survey in Pau da Lima, Salvador Brazil, with a 2010 national population-based telephone survey. NCD prevalences in both populations were similar for hypertension (23.6% (95% CI 20.9–26.4) and 22.9% (21.2–24.6), respectively) and for dyslipidemia (22.7% (19.8–25.5) and 21.5% (19.7–23.4)). Slum residents had higher prevalences of diabetes mellitus (10.1% (7.9–12.3)) and of overweight/obesity (46.5% (43.1–49.9)), compared to 5.2% (4.2–6.1) and 40.6% (38.5–42.8) of the general population in Salvador. Fourteen percent (14.5% (12.1–17.0)) of slum residents smoked cigarettes compared to 8.3% (7.1–9.5) of the general population in Salvador. The national telephone survey underestimated the prevalence of diabetes mellitus, overweight/obesity, and smoking in the slum population, likely in part due to differential sampling inside and outside of slums. Further research and targeted policies are needed to mitigate these inequalities, which could have significant economic and social impacts on slum residents and their communities

Mean relative risk for membership in age and gender groups among leptospirosis cases (A) and deaths (B).

<p>Mean and standard deviation of the relative risks are presented for males (blue bars) and females (red bars).</p

Flow diagram for selection of studies.

<p>^a65 published and 7 grey literature studies. ^bTwo published reports (<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003898#pntd.0003898.s002" target="_blank">S1 Protocol</a> references [<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003898#pntd.0003898.ref039" target="_blank">39</a>],[<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003898#pntd.0003898.ref056" target="_blank">56</a>]) were each separated into two studies as they contained separate data from urban and rural populations. ^c94 published and 2 grey literature studies.</p