Multilevel longitudinal analysis of morbidity from cardiovascular disease among elderly residents of São Paulo, Brazil

Author(s)

Kaio Henrique Correa Massa

• Document type: Doctoral Thesis
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Faculdade de Saúde Pública (FSP/CIR)
• Defense date: 2018-03-07

Examining board members

Alexandre Dias Porto Chiavegatto Filho; Jose Leopoldo Ferreira Antunes; Yeda Aparecida de Oliveira Duarte; Danielle Bivanco de Lima; Luiz Roberto Ramos

• Advisor: Alexandre Dias Porto Chiavegatto Filho

Abstract

Cardiovascular disease morbidity (CVD) is a growing concern in Public Health. An increase in the burden of CVD has been recently observed, especially in low- and middle-income countries, due to increases in life expectancy and the longer exposure period to risk factors of chronic diseases. The increase of total years lived with a chronic disease is now considered as one of the main public health concerns, especially regarding cardiovascular diseases, the highest contributor to disability-adjusted life years among the elderly. Therefore, the assessment of the total burden of chronic diseases in the population and the identification of its determinants represents an important area of concern in Public Health and healthcare policies. However, studies that have analyzed both the evolution of the CVD prevalence in the last decade and the individual and contextual determinants of cardiovascular diseases among the elderly are still scarce in Brazil. This thesis is presented in the form of three papers. The first one analyzed the effect of individual and contextual determinants of morbidity of CVD in elderly residents of Sao Paulo, Brazil, in 2010. In comparison to elderly residents in areas with the lowest level of income inequality, higher odds of CVD presence was observed among those living in areas in the mediumlow (OR=1.35, 95 per cent CI 1.15 to 1.59), mediumhigh (OR=2.71, 95 per cent CI 2.18 to 3.36) and high (OR=1.43, 95 per cent CI 1.14 to 1.79) quartiles of income inequality. Regarding green spaces, those who live in areas with highest levels of vegetation coverage had a significantly lower risk of CVD, even after controlling for individual and contextual factors. The second paper analyzed the differences in the prevalence of CVD between 2000 and 2010 and its association with socioeconomic factors and risk factors among the elderly. The prevalence of CVD in the elderly was estimated to be 17.9 per cent in 2000, 22.2 per cent in 2006 and 22.9 per cent in 2010. Regarding the prevalence observed in 2000, there was a significant increase in presence of CVD in 2006 (OR = 3.20 95 per centCI = 1.93 to 5.31) and 2010 (OR = 2.98 95 per centCI = 1.51 to 5.89). The presence of CVD was also associated with older age, smoking history, presence of diabetes and hypertension, and an inverse association was observed between CVD presence and alcohol intake. The third paper analyzed the association between grip strength and cardiovascular disease morbidity in the elderly. A significantly lower presence of CVD was observed among the elderly with higher grip strength (OR = 0.47 95 per centCI = 0.24 to 0.91), even after controlling for individual characteristics. (AU)

• FAPESP's process: 14/12716-3 - Multilevel longitudinal analysis of morbidity from cardiovascular disease among elderly residents of São Paulo, Brazil
• Grantee: Kaio Henrique Correa Massa
• Support Opportunities: Scholarships in Brazil - Doctorate