The prevalence and social patterning of chronic diseases among older people in a population undergoing health transition. A 10/66 Group cross-sectional population-based survey in the Dominican Republic

BACKGROUND: Very little of the increased attention towards chronic diseases in countries with low and middle incomes has been directed towards older people, who contribute 72% of all deaths, and 14% of all Disability Adjusted Life Years linked to this group of conditions in those regions. We aimed to study the prevalence of physical, mental and cognitive diseases and impairments among older people in the Dominican Republic, their social patterning, and their relative contributions to disability. METHODS: A cross-sectional catchment area one-phase survey of chronic disease diagnoses, physical impairments, risk factors and associated disability among 2011 people aged 65 years and over (of whom 1451 gave fasting blood samples) in Santo Domingo, Dominican Republic. RESULTS: The most prevalent diagnoses were hypertension (73.0%), anaemia (35.0%), diabetes (17.5%), depression (13.8%) and dementia (11.7%), with 39.6% meeting criteria for metabolic syndrome. After direct standardization (for age and sex) the prevalences of stroke (standardized morbidity ratio [SMR] 100) and hypertension (SMR 108) were similar to those in the United States of America National Health and Nutrition Examination Survey (NHANES reference SMR 100), while those of diabetes (SMR 83) and metabolic syndrome (SMR 72) were somewhat lower. Anaemia was three times more common than in the USA (SMR 310). Diabetes, hypertension, dyslipidaemia, obesity and the metabolic syndrome were associated with affluence and female sex. Arthritis, anaemia, dementia and stroke were strongly age-associated and these conditions were also the main independent contributors to disability. CONCLUSIONS: The prevalence of many chronic diseases is similar in predominately low socioeconomic status neighbourhoods in the Dominican Republic to that in the USA. Prevalence of age-associated conditions is likely to increase with demographic ageing. There is also scope for increases in cardiovascular disease prevalence, if, as observed in other settings undergoing the epidemiologic transition, the burden of risk factors shifts towards the less affluent. Monitoring future trends in the prevalence and social patterning of chronic diseases may help to assess the effectiveness and equity of primary and secondary prevention strategies. Specific recommendations from our research include identifying and targeting the causes of anaemia among older people, and addressing women's health disadvantages

High Prevalence of Cysticercosis in People with Epilepsy in Southern Rwanda

<div><p>Background</p><p>Neurocysticercosis (NCC), the central nervous system infection by <i>Taenia solium</i> larvae, is a preventable and treatable cause of epilepsy. In Sub-Saharan Africa, the role of NCC in epilepsy differs geographically and, overall, is poorly defined. We aimed at contributing specific, first data for Rwanda, assessing factors associated with NCC, and evaluating a real-time PCR assay to diagnose NCC in cerebrospinal fluid (CSF).</p><p>Methodology/Principal findings</p><p>At three healthcare facilities in southern Rwanda, 215 people with epilepsy (PWE) and 51 controls were clinically examined, interviewed, and tested by immunoblot for cysticerci-specific serum antibodies. Additionally, CSF samples from PWE were tested for anticysticercal antibodies by ELISA and for parasite DNA by PCR. Cranial computer tomography (CT) scans were available for 12.1% of PWE with additional symptoms suggestive of NCC. The Del Brutto criteria were applied for NCC diagnosis. Cysticerci-specific serum antibodies were found in 21.8% of PWE and 4% of controls (odds ratio (OR), 6.69; 95% confidence interval (95%CI), 1.6–58.7). Seropositivity was associated with age and lack of safe drinking water. Fifty (23.3%) PWE were considered NCC cases (definitive, based on CT scans, 7.4%; probable, mainly based on positive immunoblots, 15.8%). In CSF samples from NCC cases, anticysticercal antibodies were detected in 10% (definitive cases, 25%) and parasite DNA in 16% (definitive cases, 44%). Immunoblot-positive PWE were older (medians, 30 <i>vs.</i> 22 years), more frequently had late-onset epilepsy (at age >25 years; 43.5% <i>vs.</i> 8.5%; OR, 8.30; 95%CI, 3.5–20.0), and suffered from significantly fewer episodes of seizures in the preceding six months than immunoblot-negative PWE.</p><p>Conclusions/Significance</p><p>NCC is present and contributes to epilepsy in southern Rwanda. Systematic investigations into porcine and human cysticercosis as well as health education and hygiene measures for <i>T. solium</i> control are needed. PCR might provide an additional, highly specific tool in NCC diagnosis.</p></div

Selected characteristics of PWE with NCC (defined by a positive serum immunoblot result).

*<p>cystic lesion without scolex, single or multiple ring or nodular enhancing lesion, or parenchymal round calcification <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002558#pntd.0002558-DelBrutto2" target="_blank">[14]</a>, details given in <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002558#pntd.0002558.s002" target="_blank">Table S1</a>.</p>#<p>hydrocephalus or abnormal enhancement of the leptomeninges <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002558#pntd.0002558-DelBrutto2" target="_blank">[14]</a>.</p

Diagnostic data for all PWE with NCC according to the Del Brutto criteria.

‡<p>cystic lesion without scolex, single or multiple ring or nodular enhancing lesion, or parenchymal round calcification <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002558#pntd.0002558-DelBrutto2" target="_blank">[14]</a>, details given in <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002558#pntd.0002558.s002" target="_blank">Table S1</a>.</p>(+)*<p>, positive only with the maximum CSF volume (1.2–1.8 ml).</p>#<p>only 0.2 ml CSF for one PCR available.</p><p>n.a., no serum sample available.</p

Diagnostic data for PWE for whom no CT scans were available and who were classified “probable NCC cases” due to positive immunoblot results, clinical manifestation, and epidemiology (n = 31).

(+)*<p>, positive only with the maximum CSF volume (1.2–1.8 ml).</p>#<p>only 0.2 ml CSF for one PCR available.</p

Odds ratios and adjusted odds ratios (95% confidence intervals) for a positive immunoblot result in PWE.

a<p>, data are medians (range) for age and proportions (%, n/n) among PWE with and without a positive immunoblot;</p>b<p>, adjusted odds ratios originate from a logistic regression model including all shown variables, n = 211, correlation coefficient R² = 0.17.</p