Assessment of the association between socioeconomic inequalities and morbidity of the population

Uvod: Najveći doprinos nejednakostima u zdravlju, koje postoje kako unutar, tako i između zemalja širom sveta, pripisuje se socijalno-ekonomskim determinantama zdravlja. Što je socijalno-ekonomsko stanje ljudi gore, to je veća verovatnoća da sopstveno zdravlje procenjuju kao lošije uz češće prisustvo zdravstvenih simptoma i hroničnih stanja. Cilj ove disertacije bio je da se ispita povezanost demografskih i socijalno-ekonomskih determinanti sa obolevanjem stanovništva, da se konstruišu indeksi obolevanja uz procenu njihove pouzdanosti i validnosti, i da se izvrši analiza i poređenje socijalno-ekonomskih nejednakosti u zdravlju u 2000. i 2006. godini. Metod: U ovoj studiji korišćeni su podaci iz dva nacionalna ispitivanja zdravstvenog stanja stanovnika Republike Srbije, sprovedenih 2000. i 2006. godine po tipu studije preseka na reprezentativnom uzorku odraslih osoba uzrasta 20 i više godina (9921 u prvom i 14.522 u drugom ispitivanju). Kao instrument ispitivanja zdravlja stanovnika korišćeni su upitnici. Rezultati: Kao najučestaliji prediktori obolevanja stanovništva izdvojile su se sledeće varijable: pol, godine starosti, obrazovanje, radni status i materijalno stanje domaćinstva. Ispitanici sa nižim obrazovanjem (UO=2,69 u 2000. godini; UO=3,08 u 2006. godini), nezaposleni (UO=1,24 u 2000. godini; UO=1,53 u 2006. godini), neaktivno stanovništvo (UO=1,58 u 2000. godini; UO=1,96 u 2006. godini) i oni sa lošijim materijalnim stanjem domaćinstva (UO=4,34 u 2000. godini; UO=5,03 u 2006. godini) češće procenjuju svoje zdravlje kao loše. Vrednosti korišćenih indeksa obolevanja su veće u istraživanju iz 2000. godine, što ukazuje na bolje zdravstveno stanje stanovništva u 2006. godini...Introduction: The greatest contribution to inequalities in health both within and between countries is attributable to the socioeconomic determinants of health. The lower the socioeconomic status, the higher the probability of reporting a poor self-perceived health and the higher the prevalence of health problems and cronic conditions. The aim of this doctoral dissertation was to examine the associations between demographic, socioeconomic determinants and morbidity of the population, to construct morbidity indices with assessment of their reliability and validity, and to analyze and compare socioeconomic inequalities in health between 2000 and 2006. Methods: Data from the 2000 and the 2006 National Health Surveys for Serbia were used, conducted as cross-sectional studies on a representative sample of adults aged 20 years and over (9921 in the first survey and 14,522 in the second survey). The information on population health was obtained from the questionnaires. Results: The most frequent predictors of morbidity of the population are: gender, age, education, employment status and financial situation of the household. Respondents with lower education (OR=2,69 in year 2000; OR=3,08 in year 2006), unemployed (OR=1,24 in year 2000; OR=1,53 in year 2006), inactive (OR=1,58 in year 2000; OR=1,96 in year 2006) and those with worse financial situation of the household (OR=4,34 in year 2000; OR=5,03 in year 2006) were more likely to report poor self-perceived health. The values of used morbidity indices were higher in 2000 National Health Survey, which implies better health status of the population in 2006..

Socioeconomic inequalities, health damaging behavior, and self-perceived health in Serbia: a cross-sectional study

Aim To analyze the association of socioeconomic factors with self-perceived health in Serbia and examine whether this association can be partly explained by health behavior variables. Methods We used data from the 2007 Living Standards Measurement Study for Serbia. A representative sample of 13 831 persons aged ≥20 years was interviewed. The associations between demographic factors (age, sex, marital status, and type of settlement), socioeconomic factors (education, employment status, and household consumption tertiles), and health behavior variables (smoking, alcohol consumption) and self-perceived health were examined using logistic regression analyses. Results A stepwise gradient was found between education and self-perceived health for the total sample, men, and women. Compared to people with high education, people with low education had a 4.5 times higher chance of assessing their health as poor. Unemployed (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.29-2.10), inactive (OR, 2.82; 95% CI, 2.49-3.19), and the most deprived respondents (OR, 1.17; 95% CI, 1.02-1.34) were more likely to report poor self-perceived health than employed persons and the most affluent group. After adjustment for demographic and health behavior variables, the magnitudes of all associations decreased but remained clearly and significantly graded. Conclusions This study revealed inequalities in self-perceived health by socioeconomic position, in particular educational and employment status. The reduction of such inequalities through wisely tailored interventions that benefit people’s health should be a target of a national health policy in Serbi

The Rising Incidence and Mortality of Prostate Cancer in Belgrade Population

The purpose of this study was to analyze the epidemiological situation of prostate cancer in Belgrade population. Morbidity data were obtained from the Institute of Public Health of Serbia for the period 1999–2005. Mortality data for the period 1990–2006, were derived from the Statistical Office of Republic of Serbia. Average standardized incidence and mortality rates for the prostate cancer were 33.57 and 11.86 respectively. Standardized incidence rates of prostate cancer steadily increased from 29.34 per 100,000 in 1999 to 36.86 per 100,000 in 2005. In the observed period, the mortality rates significantly increased in the age groups 50–59 (y=2.77+0.42x, p=0.015), 70–79 (y=61.92+10.70x, p=0.000) and 80+ (y= 183.08+19.99x, p=0.000). The average annual percentage of changes (AAPC) was the highest (7.2%) for the 70–79 age group, the lowest (0.1%) for the youngest group(50), and 5% for the total. The increase of prostate cancer incidence and mortality during the observed period in Belgrade population indicate urgent need for Serbian health professionals to adopt existing evidence-based cancer control and preventive measures. A national policy including prostate specific antigen (PSA) screening should be considered

Risk Behaviors for Getting HIV Infection among University Students in Serbia

The objective of this study was to determine risk-taking behaviors for getting HIV infection among university students in Serbia. The study is based on a cross-sectional survey. Five hundred forty four undergraduate, first year students from two Belgrade universities were selected through random sampling, to answer a self-administrated anonymous questionnaire. Data were collected from 252 students from the Faculties of Medical Sciences, University of Belgrade (FMS) and 292 students from the Faculties of Arts, University of Arts Belgrade (FA). The differences between two groups of students and between students with risk and non-risk behavior were assessed by the χ2 and t-test. Besides that, multivariate techniques such as factor analysis and multivariate logistic regression were used in statistical analysis. Smoking (Odds Radio – OR=5.05, 95% Confidence Interval – CI=3.10–8.24), studying FA, (OR=4.17, 95%CI=2.69–6.46), male sex (OR=3.85, 95% CI=2.38–6.25), committing offences (OR=1.51, 95%CI=1.09–2.08) and older age (OR=1.31, 95%CI=1.10–1.55) were the most significant factors connected with the risk-taking behaviors for HIV transmission among the students. In conclusion, HIV prevention efforts must be sustained and designed to reach young people and to prevent patterns of risky behaviors before they start

Oesophageal-cancer-derived death in the population of Belgrade in a period 1989-2006

Background/Aim. Oesophageal cancer is the sixth most common cause of death from all malignant tumors in the world (fifth in men, eighth in women). This cancer was estimated to account for about 529 000 new cases and about 442 000 deaths in the year 2007. In the year 2002 the highest standardized mortality rates (per 100 000 habitants) of oesophageal carcinoma were noticed in the East Asia (men/women: 18.8/7.7) and East Africa (18.6/7.8), while the lowest were noticed in the Middle Africa (1.4/0.2) and West Africa (1.3/0.5). The aim of this descriptive epidemiologic study was to analyze epidemiologic situation of oesophageal cancer in Belgrade population during the period 1989-2006, using mortality data. Methods. Mortality data were collected from the City Organization for Statistics. In data analysis we used mortality rates which were standardized directly using those of the world population as the standard, and proportions. A denominator for mortality rates was calculated using the Belgrade population which was an average of the two latest register years (1991 and 2002). In order to analyze trend mortality from oesophageal cancer we used linear trend. Results. In Belgrade deaths from oesophageal cancer accounted for about 5.2% of all malignant tumors of intestinal system in male population, and 2.4% in female population. This cancer is, according to standardized mortality rates (per 100 000 habitants), on the fifth place in Belgrade population behind colorectal, stomach, pancreatic, liver and cholecystic cancer. During the period 1989-2006 in Belgrade 44 persons died from oesophageal carcinoma on the average each year, mainly men (75%), and the rest were women (25%). In male population during the same period we noticed a significant increase in trend mortality (y = 1.61 + 0.06x, p = 0.001), while in female population the increase of mortality was not significant. The male/female oesophageal cancer mortality ratio was 3:1. Mortality rates for oesophageal cancer rise with age in both sexes and they are highest in the age group of 70 and more years. Significant increase in mortality from oesophageal cancer was noticed in age groups 20-29 and over 70 in male population, and age group 40-49 in female population. Conclusion. Increasing trend in oesophageal mortality suggests the necessity for improving measures of primary prevention including education about risk factors for this carcinoma (smoking, alcohol consumption, hot food and drinks), early diagnosis, and treatment

Health-related Quality of Life in Children with Moderate to Severe Atopic Dermatitis

Atopic dermatitis (AD) is a common, chronic skin disease in children that may affect their quality of life (QoL). The aim of this study was to assess QoL in children in Montenegro with moderate to severe AD. A cross-sectional study was conducted at the Clinic of Dermatology and Venereology, Clinical Center of Montenegro, Podgorica, between January and December 2014. The study group included 200 children (97 boys and 103 girls) with the diagnosis of AD. The Infants’ Dermatitis Quality of Life Index (IDQOL) and the Children’s Dermatology Life Quality Index (CDLQI) were used to determine QoL for 90 infants (&lt;4 years old) and 110 children (4-16 years old), respectively. Severity of disease was measured by the three-item severity (TIS) score. The mean scores were 14.38±5.57 for IDQOL and 18.43±4.88 for CDLQI. A positive correlation was observed between AD clinical severity (TIS) and all the items of IDQOL with Spearman’s correlation coefficient (ρ) ranging from 0.31 to 0.74, and between AD clinical severity and all domains of CDLQI (ρ=0.31-0.69). The impact of AD on health-related quality of life (HRQoL) was more severe for younger girls, but only in some domains (IDQOL), and for older boys (CDLQI). The linguistically validated Serbian versions of both IDQOL and CDLQI questionnaires showed good internal consistency with Cronbach’s alpha values of 0.88 and 0.73, respectively. In conclusion, our results demonstrate that AD has a great impact on QoL. A positive correlation between clinical severity and quality of life was seen.</p

NMDA Receptor Antagonist Memantine Ameliorates Experimental Autoimmune Encephalomyelitis in Aged Rats

Aging is closely related to the main aspects of multiple sclerosis (MS). The average age of the MS population is increasing and the number of elderly MS patients is expected to increase. In addition to neurons, N-methyl-D-aspartate receptors (NMDARs) are also expressed on non-neuronal cells, such as immune cells. The aim of this study was to investigate the role of NMDARs in experimental autoimmune encephalomyelitis (EAE) in young and aged rats. Memantine, a non-competitive NMDAR antagonist, was administered to young and aged Dark Agouti rats from day 7 after immunization. Antagonizing NMDARs had a more favourable effect on clinical disease, reactivation, and apoptosis of CD4+ T cells in the target organ of aged EAE rats. The expression of the fractalkine receptor CX3CR1 was increased in memantine-treated rats, but to a greater extent in aged rats. Additionally, memantine increased Nrf2 and Nrf2-regulated enzymes’ mRNA expression in brain tissue. The concentrations of superoxide anion radicals, malondialdehyde, and advanced oxidation protein products in brain tissue were consistent with previous results. Overall, our results suggest that NMDARs play a more important role in the pathogenesis of EAE in aged than in young rats

Prevalence of metabolic syndrome in Montenegrin patients with psoriasis

Background/Aim. Increasing epidemiological studies suggest the association between psoriasis and metabolic syndrome. The aim of this study was to assess the association of metabolic syndrome and its components with psoriasis in a sample of patients from Montenegro, and to predict the factors that determine the metabolic syndrome. Methods. A case-control study was conducted at the Clinic of Dermatology and Venereology, Clinical Center of Montenegro, Podgorica, Montenegro, between January and December 2012. The study group included 101 patients with psoriasis (cases) and 126 patients with the diagnosis of dermatological disease other than psoriasis (controls) consecutively admitted to the same clinic. Results. Metabolic syndrome was more prevalent in the psoriasis patients than in the controls (48.5% vs 20.6%; OR = 2.99). In addition, the psoriasis patients were significantly more likely to be smokers (OR = 2.16) and were less physically active (OR = 0.58). Conclusion. The results of this study demonstrate a strong association between psoriasis and metabolic syndrome independent of psoriasis severity. Patients with psoriasis should be routinely screened for metabolic syndrome and its components. [Projekat Ministarstva nauke Republike Srbije, br. 175025: Clinical-epidemiological research of diseases of public health importance in Serbia

Status of cardiovascular health in the Republic of Serbia: Results from the National Health Survey.

BACKGROUND:Cardiovascular diseases (CVD) remain the most significant cause of death in low- and middle-income countries where the burden of CVD continues to rise due to the increasing incidence of CVD. The aim of this study was to assess the prevalence of ideal cardiovascular health (CVH) across sex and age groups and to analyze associations between demographic and socio-economic variables and ideal CVH metrics in the adult population of the Republic of Serbia. METHODS:Information on demographic (age, sex, marital status, and type of settlement) and socio-economic characteristics (education, and wealth index), and the 7 ideal CVH metrics (smoking, physical activity, healthy diet, BMI, blood pressure, cholesterol, and glucose) was obtained for 13100 respondents aged 20 years and above, from the 2013 National Health Survey in the Republic of Serbia. According to the American Heart Association, the ideal CVH was defined as the simultaneous presence of 7 ideal CVH metrics. RESULTS:Out of all ideal CVH metrics, the most prevalent components were ideal glucose (92.2%), ideal cholesterol (86.4%) and ideal smoking (63%), while the least prevalent ideal CVH component was ideal healthy diet (2.4%). Only 0.1% had all 7 CVH components at the ideal level. According to the multivariable logistic regression analysis the higher number of ideal CVH metrics was observed in women (OR = 4.46), younger people (OR = 7.12), people living without partner (OR = 1.70), more educated (OR = 2.51 for middle educated and OR = 3.57 for high educated), as well as among the rich (OR = 1.43). CONCLUSION:Our findings of existing age-specific, sex and socio-economic differences in the prevalence and number of ideal CVH metrics should serve for the development of appropriate CVD prevention policies tailored to fit specific needs of both sexes, all age groups and people with different socioeconomic status