Prevention of Cardiovascular Diseases in Deprived Neighbourhoods

Worldwide, cardiovascular diseases (CVD) remain the leading cause of morbidity and mortality even though mortality rates in the industrialised countries have declined over the past decades. Recent WHO reports show that an estimated 17 million people die every year of CVD, particularly from myocardial infarction and strokes [1]. In Western countries, such as the Netherlands, discrepancies in cardiovascular morbidity and mortality according to ethnicity and socio-economic status still exist [2,3]. Although improvements have been made in reducing cardiovascular mortality and morbidity at the national level, the prevalence of cardiovascular risk factors (such as smoking behaviour and overweight) is higher among individuals with a low socio-economic status and, more specifi cally, among ethnic minorities than those people with a high socio-economic status and the indigenous Dutch population [4-6]. Persons with a low socio-economic status and ethnic minorities mainly live in the so-called deprived neighbourhoods [7]. In the Netherlands, neighbourhoods are identifi ed as “deprived” according to an index based on income, the number of individuals that depend on social benefi ts, and the level of urbanisation [8]

Different distribution of cardiovascular risk factors according to ethnicity: A study in a high risk population

This study compares the distribution of cardiovascular risk factors in different ethnic groups at high risk of developing cardiovascular diseases within general practices. A total of 430 patients (179 Dutch, 126 Turks, 50 Surinamese, 23 Moroccans, 23 Antilleans and 29 from other ethnic groups) were included in the study. Data collection consisted of questionnaires and physical and clinical examinations. 54% was female. The mean age was 53.1 (sd 9.9) years. There were important ethnic differences in the distribution of cardiovascular risk factors. Compared to the Dutch, ethnic minorities had significantly greater odds of being diabetic (OR = 3.2-19.4); but were less likely to smoke (OR = 0.10-0.53). Turkish individuals had a lower prevalence of hypercholesterolemia but were 2.4 times more likely to be obese than the Dutch. Hypertension was very common in all ethnic groups and no significant ethnic differences were found. These findings provide additional evidence of the need for tailored interventions for different ethnic groups in general practices

A longitudinal study on determinants of HPV vaccination uptake in parents/guardians from different ethnic backgrounds in Amsterdam, the Netherlands

Human papillomavirus (HPV) vaccination coverage in the Netherlands is low (~60%) compared to other childhood vaccinations (>90%), and even lower among ethnic minorities. The aim of this study was to explore the possible impact of ethnicity on the determinants of both HPV vaccination intention and HPV vaccination uptake among parents/guardians having a daughter that is invited for the HPV vaccination. In February 2014, parents/guardians living in Amsterdam were invited to complete a questionnaire about social-psychological determinants of their decision making process regarding the HPV vaccination of their daughter and socio-demographic characteristics. This questionnaire was sent approximately one month before the daughter was scheduled to receive her first HPV vaccine dose. Their daughters' HPV vaccination status was retrieved from the national vaccination database. We distinguished four ethnic groups: Dutch (NL), Surinamese, Netherlands Antillean, and Aruban (SNA), Middle-Eastern and North-African (MENA), and Other. To assess the impact of determinants on both intention and uptake, linear and logistic regression analyses were used respectively. Missing data were imputed using multiple imputation by chained equation. In total 1,309 parents/guardians participated (33% participation rate). In all groups we found the mothers' intention to be the strongest predictor of their daughters' HPV vaccination uptake. Explained variance of uptake was highest in the NL-group (pseudo-R(2):0.56) and lower in the other ethnic groups (pseudo-R(2) varied between 0.23 and 0.29). The lower explained variance can be attributed to the relative large proportion of participants with a positive intention that finally did not go for vaccination in the SNA-group (11%) and MENA-group (30%). Explained variance (R(2)) of intention varied between 0.66 and 0.77 across ethnic groups, and was best explained by the proximal social-psychological determinants. The strength of association of these determinants with both intention and uptake were largely similar across ethnic groups. We conclude that the same determinants should be targeted in the different ethnic groups, although the mode of delivery of the intervention needs to be tailored to the different cultural backgrounds. Further research is needed to explain the observed discrepancy between intention and uptake, especially among parents/guardians in the non-Dutch group