Association of Socioeconomic Position and Demographic Characteristics with Cardiovascular Disease Risk Factors and Healthcare Access among Adults Living in Pohnpei, Federated States of Micronesia
Corresponding Author
G. M. Hosey
Division of Diabetes Translation, Centers for Disease Control and Prevention, National Center for Chronic Disease and Health Promotion, 4770 Buford Highway, Mailstop K10, Atlanta, GA 30341, USA cdc.gov
Search for more papers by this authorM. Samo
Department of Health and Social Affairs, Federated States of Micronesia National Government, P.O. Box PS70, Palikir, FM 96941, USA fsmgov.org
Search for more papers by this authorE. W. Gregg
Division of Diabetes Translation, Centers for Disease Control and Prevention, National Center for Chronic Disease and Health Promotion, 4770 Buford Highway, Mailstop K10, Atlanta, GA 30341, USA cdc.gov
Search for more papers by this authorL. Barker
Division of Diabetes Translation, Centers for Disease Control and Prevention, National Center for Chronic Disease and Health Promotion, 4770 Buford Highway, Mailstop K10, Atlanta, GA 30341, USA cdc.gov
Search for more papers by this authorD. Padden
Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA usuhs.mil
Search for more papers by this authorS. G. Bibb
Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA usuhs.mil
Search for more papers by this authorCorresponding Author
G. M. Hosey
Division of Diabetes Translation, Centers for Disease Control and Prevention, National Center for Chronic Disease and Health Promotion, 4770 Buford Highway, Mailstop K10, Atlanta, GA 30341, USA cdc.gov
Search for more papers by this authorM. Samo
Department of Health and Social Affairs, Federated States of Micronesia National Government, P.O. Box PS70, Palikir, FM 96941, USA fsmgov.org
Search for more papers by this authorE. W. Gregg
Division of Diabetes Translation, Centers for Disease Control and Prevention, National Center for Chronic Disease and Health Promotion, 4770 Buford Highway, Mailstop K10, Atlanta, GA 30341, USA cdc.gov
Search for more papers by this authorL. Barker
Division of Diabetes Translation, Centers for Disease Control and Prevention, National Center for Chronic Disease and Health Promotion, 4770 Buford Highway, Mailstop K10, Atlanta, GA 30341, USA cdc.gov
Search for more papers by this authorD. Padden
Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA usuhs.mil
Search for more papers by this authorS. G. Bibb
Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA usuhs.mil
Search for more papers by this authorAbstract
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.
References
- 1 Hall H. I., Correa A., Yoon P. W., and Braden C. R., Lexicon, definitions, and conceptual framework for public health surveillance, Morbidity and Mortality Weekly Report: Surveillance Summaries. (2012) 61, 10–14, 2-s2.0-84866923893.
- 2 Murray C. J., Vos T., Lozano R. 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. (2010) 380, no. 9859, 2197–2223, https://doi.org/10.1016/S0140-6736(12)61689-4.
- 3 Lim S. S., Vos T., Flaxman A. D. 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. (2010) 380, no. 9859, 2224–2260, https://doi.org/10.1016/S0140-6736(12)61766-8.
- 4 World Health Organization, Global Status Report on Noncommunicable Diseases 2010, 2010, World Health Organization, Geneva, Switzerland, http://www.who.int/nmh/publications/ncd_report_full_en.pdf.
- 5 Kaplan G. A. and Keil J. E., Socioeconomic factors and cardiovascular disease: a review of the literature, Circulation. (1993) 88, no. 4, part 1, 1973–1998, https://doi.org/10.1161/01.cir.88.4.1973, 2-s2.0-0027376801.
- 6 N. E. Adler and J. Stewart, The Biology of Disadvantage: Socioeconomic Status and Health, 2010, 1186, Annals of the New York Academy of Sciences.
- 7 Gaziano T. A., Bitton A., Anand S., Abrahams-Gessel S., and Murphy A., Growing epidemic of coronary heart disease in low- and middle-income countries, Current Problems in Cardiology. (2010) 35, no. 2, 72–115, 2-s2.0-72749104236, https://doi.org/10.1016/j.cpcardiol.2009.10.002.
- 8 Reddy K. S., Cardiovascular disease in non-Western countries, The New England Journal of Medicine. (2004) 350, no. 24, 2438–2440, https://doi.org/10.1056/nejmp048024, 2-s2.0-2942592213.
- 9 NCD Risk Factors STEPS Report, 2008, Department of Health and Social Affairs, Pohnpei, Federated States of Micronesia.
- 10 Phillips S. P., Defining and measuring gender: a social determinant of health whose time has come, International Journal for Equity in Health. (2005) 4, article 11, https://doi.org/10.1186/1475-9276-4-11, 2-s2.0-23244434237.
- 11 Aday L. A. and Andersen R. M., Equity of access to medical care: a conceptual and empirical overview, Medical Care. (1981) 19, no. 12, 4–27, https://doi.org/10.1097/00005650-198112001-00004, 2-s2.0-0019772827.
- 12 Whiteworth J. A., World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension, Journal of Hypertension. (2003) 21, no. 11, 1893–1892.
- 13 World Health Organization, Waist Circumference and Waist-Hip Ratio. Report of a WHO Expert Consultation, 2011, World Health Organization, Geneva, Switzerland, http://whqlibdoc.who.int/publications/2011/9789241501491_eng.pdf.
- 14 American Diabetes Association, Standards of medical care in diabetes—2013, Diabetes Care. (2013) 36, no. supplement 1, S11–S66.
- 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, 2010, World Health Organization, Geneva, Switzerland, http://www.who.int/gho/publications/world_health_statistics/EN_WHS2012_Full.pdf.
- 17 Hosseinpoor A. R., Parker L. A., Tursan d′Espaignet E., and Chatterji S., Social determinants of smoking in low- and middle-income countries: results from the world health survey, PLoS ONE. (2011) 6, no. 5, e20331, https://doi.org/10.1371/journal.pone.0020331, 2-s2.0-79957798756.
- 18
Giovino G. A.,
Mirza S. A.,
Samet J. M.,
Gupta P. C.,
Jarvis M. J.,
Bhala N.,
Peto R.,
Zatonski W.,
Hsia J.,
Morton J.,
Palipudi K. M., and
Asma S., Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative cross-sectional household surveys, The Lancet. (2012) 380, no. 9842, 668–679, https://doi.org/10.1016/s0140-6736(12)61085-x, 2-s2.0-84865142868.
10.1016/S0140-6736(12)61085-X Google Scholar
- 19 Huxley R., Mendis S., Zheleznyakov E., Reddy S., and Chan J., Body mass index, waist circumference and waist:hip ratio as predictors of cardiovascular risk—a review of the literature, European Journal of Clinical Nutrition. (2010) 64, no. 1, 16–22, https://doi.org/10.1038/ejcn.2009.68, 2-s2.0-75049085446.
- 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, 2000, National Institutes of Health, Rockville, Md, USA, http://www.nhlbi.nih.gov/guidelines/obesity/prctgd_c.pdf.
- 21 Minh H. V., Byass P., Dao L. H., Nguyen T., and Wall S., 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. (2007) 4, no. 2.
- 22 Fleischer N. L., Roux A. V. D., Alazraqui M., and Spinelli H., Social patterning of chronic disease risk factors in a Latin American city, The Journal of Urban Health. (2008) 85, no. 6, 923–937, https://doi.org/10.1007/s11524-008-9319-2, 2-s2.0-57049112624.
- 23 Marins V. M. R., Almeida R. M. V. R., Pereira R. A., and Sichieri R., The association between socioeconomic indicators and cardiovascular disease risk factors in Rio de Janeiro, Brazil, Journal of Biosocial Science. (2007) 39, no. 2, 221–229, https://doi.org/10.1017/S0021932006001246, 2-s2.0-33847662972.
- 24 Pearson T. A., Education and income: double-edged swords in the epidemiologic transition of cardiovascular disease, Ethnicity & Disease. (2003) 13, no. 2, supplement 2, S158–S163, 2-s2.0-1542604360.
- 25 McKeown R., The epidemiologic transition: changing patterns of mortality and population dynamics, The American Journal of Lifestyle Medicine. (2009) 3, no. 1, supplement, 19S–26S, https://doi.org/10.1177/1559827609335350.
- 26 Patrick R. C., Prior I. A. M., Smith J. C., and Smith A. H., Relationship between blood pressure and modernity among Ponapeans, International Journal of Epidemiology. (1983) 12, no. 1, 36–44, https://doi.org/10.1093/ije/12.1.36, 2-s2.0-0020658618.
- 27 Ezeamama A. E., Viali S., Tuitele J., and McGarvey S. T., The influence of socioeconomic factors on cardiovascular disease risk factors in the context of economic development in the Samoan archipelago, Social Science and Medicine. (2006) 63, no. 10, 2533–2545, https://doi.org/10.1016/j.socscimed.2006.06.023, 2-s2.0-33749425517.
- 28 Read J. G. and Gorman B. K., Gender and health inequality, Annual Review of Sociology. (2010) 36, 371–386, https://doi.org/10.1146/annurev.soc.012809.102535.
- 29 Ranji U. and Salganico A., Women′s Health Care Chartbook. Key Findings from the Kaiser Women′s Health Survey, 2011, Kaiser Family Foundation, Menlo Park, Calif, USA.
- 30 McWilliams J. M., Health consequences of uninsurance among adults in the United States: recent evidence and implications, Milbank Quarterly. (2009) 87, no. 2, 443–494, https://doi.org/10.1111/j.1468-0009.2009.00564.x, 2-s2.0-66849109238.
- 31 Smyth J. M., Webb M. S., and Oikaya M., Self-report of cancer-related behaviors, Syracuse University, Syracuse, NY, USA, 2007, http://cancercontrol.cancer.gov/brp/constructs/self-report/self-report.pdf.
- 32 Englberger L., Lorens A., Pretrick M., Tara M. J., and Johnson E., Local food policies can help promote local foods and improve health: a case study from the Federated States of Micronesia, Hawaii Medical Journal. (2011) 70, no. 11 supplement 2, 31–34, 2-s2.0-84875810208.
- 33 WHO Western Pacific Region, Noncommunicable diseases in the Western Pacific Region, 2012, World Health Organization, Geneva, Switzerland, http://www.wpro.who.int/noncommunicable_diseases/documents/ncd_in_the_wpr.pdf.
- 34 Nguyen Q. N., Pham S. T., Do L. D., Nguyen V. L., Wall S., Weinehall L., Bonita R., and Byass P., Cardiovascular disease risk factor patterns and their implications for intervention strategies in vietnam, International Journal of Hypertension. (2012) 2012, 11, 560397, https://doi.org/10.1155/2012/560397, 2-s2.0-84865033909.
- 35 Institute of Medicine, Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health, 2010, The National Academies Press, Washington, DC, USA, http://www.ncbi.nlm.nih.gov/books/NBK45688.
