Association of Socioeconomic Position and Demographic Characteristics with Cardiovascular Disease Risk Factors and Healthcare Access among Adults Living in Pohnpei, Federated States of Micronesia
Background. The burden of cardiovascular disease (CVD) is increasing in low-to-middle income countries. We examined how socioeconomic and demographic characteristics may be associated with CVD risk factors and healthcare access in such countries. Methods. We extracted data from the World Health Organization’s STEPwise approach to surveillance 2002 cross-sectional dataset from Pohnpei, Federated States of Micronesia (FSM). We used these data to estimate associations for socioeconomic position (education, income, and employment) and demographics (age, sex, and urban/rural) with CVD risk factors and with healthcare access, among a sample of 1638 adults (25–64 years). Results. In general, we found significantly higher proportions of daily tobacco use among men than women and respondents reporting primary-level education (<9 years) than among those with postsecondary education (>12 years). Results also revealed significant positive associations between paid employment and waist circumference and systolic blood pressure. Healthcare access did not differ significantly by socioeconomic position. Women reported significantly higher mean waist circumference than men. Conclusion. Our results suggest that socioeconomic position and demographic characteristics impact CVD risk factors and healthcare access in FSM. This understanding may help decision-makers tailor population-level policies and programs. The 2002 Pohnpei data provides a baseline; subsequent population health surveillance data might define trends. 1. Introduction Population-based surveillance—the ongoing systematic collection, analysis, and interpretation of health data—is critical for providing information on which to base policy; prioritize resources; guide program planning, evaluation, and research; and protect and promote population health [1]. The World Bank defines lower to middle income countries (LMICs) as countries where residents have mean income less than $12,615 (2012, http://data.worldbank.org/about/country-classifications). In LMIC, the burden of cardiovascular disease (CVD) is increasing at faster rates than those experienced by high-income countries in previous decades, elevating the need to strengthen country-level surveillance [2, 3]. Worldwide, over 80% of CVD deaths occur in LMICs [4]. Additionally, in LMICs, 29% of deaths from chronic noncommunicable diseases occur before the age of 60 years, compared to 13% in high-income countries [4]. Research evidence, primarily from high-income countries, shows an inverse association for indicators of socioeconomic position, measured by
References
[1]
H. I. Hall, A. Correa, P. W. Yoon, and C. R. Braden, “Lexicon, definitions, and conceptual framework for public health surveillance,” Morbidity and Mortality Weekly Report: Surveillance Summaries, vol. 61, pp. 10–14, 2012.
[2]
C. J. Murray, T. Vos, R. Lozano, et al., “Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010,” The Lancet, vol. 380, no. 9859, pp. 2197–2223, 2010.
[3]
S. S. Lim, T. Vos, A. D. Flaxman, et al., “A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010,” The Lancet, vol. 380, no. 9859, pp. 2224–2260, 2010.
[4]
World Health Organization, Global Status Report on Noncommunicable Diseases 2010, World Health Organization, Geneva, Switzerland, 2010, http://www.who.int/nmh/publications/ncd_report_full_en.pdf.
[5]
G. A. Kaplan and J. E. Keil, “Socioeconomic factors and cardiovascular disease: a review of the literature,” Circulation, vol. 88, no. 4, part 1, pp. 1973–1998, 1993.
[6]
N. E. Adler and J. Stewart, Eds., The Biology of Disadvantage: Socioeconomic Status and Health, vol. 1186, Annals of the New York Academy of Sciences, 2010.
[7]
T. A. Gaziano, A. Bitton, S. Anand, S. Abrahams-Gessel, and A. Murphy, “Growing epidemic of coronary heart disease in low- and middle-income countries,” Current Problems in Cardiology, vol. 35, no. 2, pp. 72–115, 2010.
[8]
K. S. Reddy, “Cardiovascular disease in non-Western countries,” The New England Journal of Medicine, vol. 350, no. 24, pp. 2438–2440, 2004.
[9]
NCD Risk Factors STEPS Report, Department of Health and Social Affairs, Pohnpei, Federated States of Micronesia, 2008.
[10]
S. P. Phillips, “Defining and measuring gender: a social determinant of health whose time has come,” International Journal for Equity in Health, vol. 4, article 11, 2005.
[11]
L. A. Aday and R. M. Andersen, “Equity of access to medical care: a conceptual and empirical overview,” Medical Care, vol. 19, no. 12, pp. 4–27, 1981.
[12]
J. A. Whiteworth, “World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension,” Journal of Hypertension, vol. 21, no. 11, pp. 1893–1892, 2003.
[13]
World Health Organization, Waist Circumference and Waist-Hip Ratio. Report of a WHO Expert Consultation, World Health Organization, Geneva, Switzerland, 2011, http://whqlibdoc.who.int/publications/2011/9789241501491_eng.pdf.
[14]
American Diabetes Association, “Standards of medical care in diabetes—2013,” Diabetes Care, vol. 36, supplement 1, pp. S11–S66, 2013.
[15]
National Cholesterol Education Program (NCEP), “Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III),” http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3full.pdf.
[16]
World Health Organization, World Health Statistics 2012, World Health Organization, Geneva, Switzerland, 2010, http://www.who.int/gho/publications/world_health_statistics/EN_WHS2012_Full.pdf.
[17]
A. R. Hosseinpoor, L. A. Parker, E. Tursan d'Espaignet, and S. Chatterji, “Social determinants of smoking in low- and middle-income countries: results from the world health survey,” PLoS ONE, vol. 6, no. 5, Article ID e20331, 2011.
[18]
G. A. Giovino, S. A. Mirza, J. M. Samet et al., “Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative cross-sectional household surveys,” The Lancet, vol. 380, no. 9842, pp. 668–679, 2012.
[19]
R. Huxley, S. Mendis, E. Zheleznyakov, S. Reddy, and J. Chan, “Body mass index, waist circumference and waist:hip ratio as predictors of cardiovascular risk—a review of the literature,” European Journal of Clinical Nutrition, vol. 64, no. 1, pp. 16–22, 2010.
[20]
National Institutes of Health (NIH) and North American Association for the Study of Obesity (NAASO), The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, National Institutes of Health, Rockville, Md, USA, 2000, http://www.nhlbi.nih.gov/guidelines/obesity/prctgd_c.pdf.
[21]
H. V. Minh, P. Byass, L. H. Dao, T. Nguyen, and S. Wall, “Risk factors for chronic disease among rural Vietnamese adults and the association of these factors with sociodemographic variables: findings from the WHO STEPS survey in rural Vietnam, 2005,” Preventing Chronic Disease, vol. 4, no. 2, p. A22, 2007.
[22]
N. L. Fleischer, A. V. D. Roux, M. Alazraqui, and H. Spinelli, “Social patterning of chronic disease risk factors in a Latin American city,” The Journal of Urban Health, vol. 85, no. 6, pp. 923–937, 2008.
[23]
V. M. R. Marins, R. M. V. R. Almeida, R. A. Pereira, and R. Sichieri, “The association between socioeconomic indicators and cardiovascular disease risk factors in Rio de Janeiro, Brazil,” Journal of Biosocial Science, vol. 39, no. 2, pp. 221–229, 2007.
[24]
T. A. Pearson, “Education and income: double-edged swords in the epidemiologic transition of cardiovascular disease,” Ethnicity & Disease, vol. 13, no. 2, supplement 2, pp. S158–S163, 2003.
[25]
R. McKeown, “The epidemiologic transition: changing patterns of mortality and population dynamics,” The American Journal of Lifestyle Medicine, vol. 3, no. 1, supplement, pp. 19S–26S, 2009.
[26]
R. C. Patrick, I. A. M. Prior, J. C. Smith, and A. H. Smith, “Relationship between blood pressure and modernity among Ponapeans,” International Journal of Epidemiology, vol. 12, no. 1, pp. 36–44, 1983.
[27]
A. E. Ezeamama, S. Viali, J. Tuitele, and S. T. McGarvey, “The influence of socioeconomic factors on cardiovascular disease risk factors in the context of economic development in the Samoan archipelago,” Social Science and Medicine, vol. 63, no. 10, pp. 2533–2545, 2006.
[28]
J. G. Read and B. K. Gorman, “Gender and health inequality,” Annual Review of Sociology, vol. 36, pp. 371–386, 2010.
[29]
U. Ranji and A. Salganico, Women's Health Care Chartbook. Key Findings from the Kaiser Women's Health Survey, Kaiser Family Foundation, Menlo Park, Calif, USA, 2011.
[30]
J. M. McWilliams, “Health consequences of uninsurance among adults in the United States: recent evidence and implications,” Milbank Quarterly, vol. 87, no. 2, pp. 443–494, 2009.
[31]
J. M. Smyth, M. S. Webb, and M. Oikaya, “Self-report of cancer-related behaviors,” Syracuse University, Syracuse, NY, USA, 2007, http://cancercontrol.cancer.gov/brp/constructs/self-report/self-report.pdf.
[32]
L. Englberger, A. Lorens, M. Pretrick, M. J. Tara, and E. Johnson, “Local food policies can help promote local foods and improve health: a case study from the Federated States of Micronesia,” Hawaii Medical Journal, vol. 70, supplement 2, no. 11, pp. 31–34, 2011.
[33]
WHO Western Pacific Region, Noncommunicable diseases in the Western Pacific Region, World Health Organization, Geneva, Switzerland, 2012, http://www.wpro.who.int/noncommunicable_diseases/documents/ncd_in_the_wpr.pdf.
[34]
Q. N. Nguyen, S. T. Pham, L. D. Do et al., “Cardiovascular disease risk factor patterns and their implications for intervention strategies in vietnam,” International Journal of Hypertension, vol. 2012, Article ID 560397, 11 pages, 2012.
[35]
Institute of Medicine, Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health, The National Academies Press, Washington, DC, USA, 2010, http://www.ncbi.nlm.nih.gov/books/NBK45688.
