Dataset Information

Marginalisation and cardiovascular disease among rural Sami in Northern Norway: a population-based cross-sectional study.

ABSTRACT:

Background

Like other indigenous peoples, the Sami have been exposed to the huge pressures of colonisation, rapid modernisation and subsequent marginalisation. Previous studies among indigenous peoples show that colonialism, rapid modernisation and marginalisation is accompanied by increased stress, an unhealthy cardiovascular risk factor profile and disease burden. Updated data on the general burden of cardiovascular disease among the Sami is lacking. The primary objective of this study was to assess the relationship between marginalisation and self-reported lifetime cardiovascular disease (CVD) by minority/majority status in the rural Sami population of Norway.

Methods

A cross-sectional population-based study (the SAMINOR study) was carried out in 2003-2004. The overall participation rate was 60.9% and a total of 4027 Sami individuals aged 36-79 years were included in the analyses. Data was collected by self-administrated questionnaires and a clinical examination.

Results

The logistic regression showed that marginalised Sami living in Norwegian dominated areas were more than twice as likely to report CVD as non-marginalised Sami living in Sami majority areas (OR 2.10, 95% CI: 1.40-3.14). No sex difference was found in the effects of marginalisation on self-reported life-time cardiovascular disease. Moderate to no intermediate effects were seen after including established CVD risk factors.

Conclusions

This study showed that marginalised Sami living in Norwegian dominated areas were more than twice as likely as non-marginalised Sami from Sami majority areas to report lifetime cardiovascular disease (CVD). Moderate to no intermediate effects were seen after including established CVD risk factors, which suggest little difference in lifestyle related factors. Chronic stress exposure following marginalisation may however be a plausible explanation for some of the observed excess of CVD.

SUBMITTER: Eliassen BM

PROVIDER: S-EPMC3668238 | biostudies-literature | 2013 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Marginalisation and cardiovascular disease among rural Sami in Northern Norway: a population-based cross-sectional study.

Eliassen Bent-Martin BM Melhus Marita M Hansen Ketil Lenert KL Broderstad Ann Ragnhild AR

BMC public health 20130529

<h4>Background</h4>Like other indigenous peoples, the Sami have been exposed to the huge pressures of colonisation, rapid modernisation and subsequent marginalisation. Previous studies among indigenous peoples show that colonialism, rapid modernisation and marginalisation is accompanied by increased stress, an unhealthy cardiovascular risk factor profile and disease burden. Updated data on the general burden of cardiovascular disease among the Sami is lacking. The primary objective of this study ...[more]

PMID: 23718264

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Project description:ObjectiveTo examine the change in both the prevalence and severity of metabolic syndrome (MetS) in the Sami and non-Sami in Northern Norway due to a lack of knowledge regarding the development of MetS in this population.DesignRepeated cross-sectional study.SettingThe study is based on data from the SAMINOR 1 Survey (2003-2004, n=6550) and the SAMINOR 2 Clinical Survey (2012-2014, n=6004), conducted in 10 municipalities in Northern Norway.ParticipantsMen and women aged 40-79 years were invited. We excluded participants not handing in the questionnaire and with missing information concerning ethnicity questions or MetS risk factors resulting in a final sample of 6308 (36.0% Sami) subjects in SAMINOR 1 and 5866 (40.9% Sami) subjects in SAMINOR 2.Outcome measuresMetS prevalence was determined using the harmonised Adult Treatment Panel III (ATP-III) criteria, and severity was assessed with the MetS severity Z-score. Generalised estimating equations with an interaction term (survey × ethnicity) were used to compare prevalence and severity between the two surveys while accounting for partly repeated measurements.ResultsThe overall, age-standardised ATP-III-MetS prevalence was 31.2% (95% CI: 29.8 to 32.6) in SAMINOR 1 and 35.6% (95% CI: 34.0 to 37.3) in SAMINOR 2. Both the ATP-III-MetS prevalence and the mean MetS severity Z-score increased between the surveys in all subgroups, except the ATP-III-MetS prevalence in non-Sami women, which remained stable. Over time, Sami men showed a slightly larger increase in MetS severity than non-Sami men (p<0.001): the score increased by 0.20 (95% CI: 0.14 to 0.25) and 0.06 (95% CI: 0.01 to 0.10) in Sami and non-Sami men, respectively. Abdominal obesity increased markedly between the surveys in all subgroups.ConclusionThe prevalence and severity of MetS increased over time in rural Northern Norway. Abdominal obesity appeared to drive the increase in ATP-III-MetS prevalence. Sami men had a slightly larger increase in severity than non-Sami.

Project description:BACKGROUND:Sex-based differences in cardiovascular disease (CVD) burden are widely acknowledged, with male sex considered a risk factor in high-income settings. However, these relationships have not been examined in sub-Saharan Africa (SSA). We aimed to apply the American Heart Association (AHA) ideal cardiovascular health (CVH) tool modified by the addition of C-reactive protein (CRP) to examine potential sex-based differences in the prevalence of CVD risk in rural Uganda. METHODS:In a cross-sectional study nested within a population-wide census, 857 community-living adults completed physical and laboratory-based assessments to calculate individual ideal CVH metrics including an eight category for CRP levels. We summarized sex-specific ideal CVH indices, fitting ordinal logistic regression models to identify correlates of improving CVH. As secondary outcomes, we assessed subscales of ideal CVH behaviours and factors. Models included inverse probability of sampling weights to determine population-level estimates. RESULTS:The weighted-population mean age was 39.2 (1.2) years with 52.0 (3.7) % females. Women had ideal scores in smoking (80.4% vs. 68.0%; p < 0.001) and dietary intake (26.7% vs. 16.8%; p = 0.037) versus men, but the opposite in body mass index (47.3% vs. 84.4%; p < 0.001), glycated hemoglobin (87.4% vs. 95.2%; p = 0.001), total cholesterol (80.2% vs. 85.0%; p = 0.039) and CRP (30.8% vs. 49.7%; p = 0.009). Overall, significantly more men than women were classified as having optimal cardiovascular health (6-8 metrics attaining ideal level) (39.7% vs. 29.0%; p = 0.025). In adjusted models, female sex was correlated with lower CVH health factors sub-scales but higher ideal CVH behaviors. CONCLUSIONS:Contrary to findings in much of the world, female sex in rural SSA is associated with worse ideal CVH profiles, despite women having better indices for ideal CVH behaviors. Future work should assess the potential role of socio-behavioural sex-specific risk factors for ideal CVH in SSA, and better define the downstream consequences of these differences.

Project description:BACKGROUND:Few population-based studies have assessed dietary behaviors in the rural multiethnic population of Northern Norway. The present study determined dietary patterns and investigated their association with Sami ethnicity, sociodemographic factors, and lifestyle factors in a multiethnic population in rural Northern Norway. METHODS:This cross-sectional study included 4504 participants of the SAMINOR 2 Clinical Survey (2012-2014) aged 40-69?years. All participants completed a lifestyle and food frequency questionnaire. Dietary patterns were determined using principal component analysis. Associations between food patterns and ethnicity, sociodemographic factors, and lifestyle factors were examined by multiple linear regression. RESULTS:Six dietary patterns were identified that accounted for 28% of the variability in food intake in the study sample: 'processed meat/westernized', 'fish/traditional', 'fruit/vegetables', 'reindeer/traditional', 'bread and sandwich spreads', and 'sweets and bakery goods'. The 'reindeer/traditional' pattern was most common among the inland Sami population. The 'fish/traditional' pattern was most common among costal multiethnic Sami and least common among inland Sami and among women independent of ethnicity. The 'fish/traditional' pattern was also positively associated with older age, high education level, small household size, and smoking. Adherence to the 'processed meat/westernized' pattern was lower among inland Sami than inland/coastal non-Sami; no ethnic differences in adherence to this pattern were found between costal multiethnic Sami and inland/coastal non-Sami. Unhealthy lifestyle factors, like low physical activity level and smoking, and younger age were mainly associated with the 'processed meat/westernized' pattern, whereas socioeconomic factors like low education, low gross annual household income, and large household size were related to the 'sweets and bakery goods' pattern. Male gender, low education level, and smoking were associated with the 'bread and sandwich spreads' pattern. The 'fruit/vegetables' pattern was characterized by healthy dietary choices and a health-conscious lifestyle, and was more common in women with a high education level and income. CONCLUSIONS:Adherence to the six identified dietary patterns was characterized by different sociodemographic and lifestyle factors. Ethnicity, in combination with geographical region of residence, was associated with dietary behaviors. This study provides knowledge that will be useful in future studies on dietary patterns related to chronic diseases in the rural population of Northern Norway.

Project description:OBJECTIVES:Underestimation of overweight/obesity may prevent weight loss attempts, resulting in further weight gain and maintenance of overweight. Mental health benefits may nevertheless surpass negative consequences. Our main objective was to study the association between underestimation of overweight/obesity and symptoms of anxiety and depression in Sami and non-Sami populations. DESIGN:Population-based cross-sectional study. SETTING:The SAMINOR 2 Clinical Study with participants from 10 municipalities in Northern Norway enrolled between 2012 and 2014. PARTICIPANTS:The study included 3266 adults of multiethnic rural origin with overweight/obesity (body mass index (BMI) ≥25 kg/m2) whereof 1384 underestimated their weight (42%). PRIMARY AND SECONDARY OUTCOME MEASURES:Primary outcome measure was symptoms of anxiety and depression and secondary outcome measures were BMI and the demographic variables: sex, age, education and marital status. RESULTS:A higher proportion of Sami men compared with non-Sami men were obese, and reported more symptoms of anxiety and depression. More men than women, and a higher proportion of Sami women compared with non-Sami women, underestimated their weight. Multivariable-adjusted analyses showed that women were less likely to underestimate their weight compared with men (OR 0.43, 95% CI 0.33 to 0.55 in Sami and OR 0.33, 95% CI 0.26 to 0.42 in non-Sami), higher BMI was protective against weight underestimation (OR 0.72, 95% CI 0.69 to 0.75 in Sami and OR 0.63, 95% CI 0.60 to 0.67 in non-Sami), slightly higher odds of weight underestimation were observed with increasing age in both ethnic groups (OR 1.03, 95% CI 1.01 to 1.05 in Sami and OR 1.02, 95% CI 1.00 to 1.03 in non-Sami), while higher education lowered the odds in non-Sami (OR 0.69, 95% CI 0.55 to 0.87). Weight underestimation was protectively associated with anxiety and depression in Sami men (OR 0.48, 95% CI 0.27 to 0.84) and in non-Sami women (OR 0.44, 95% CI 0.25 to 0.78) adjusted for age, BMI, education and marital status. CONCLUSIONS:Independent of ethnicity, more men than women underestimated their weight. Underestimation of weight was protectively associated with anxiety and depression in Sami men and non-Sami women.

Project description:BackgroundCoronary artery disease, fatty liver disease, cardiac abnormalities, the metabolic syndrome, and insulin resistance may all occur in association with an increase of epicardial adipose tissue volume (EATV). Previous studies have shown that some cardiovascular-risk factors and healthy behaviors were related to a lower risk of EATV increase. The main purpose of this study was to determine whether ideal cardiovascular health (CVH) metrics were correlated with the prevalence of high EATV.MethodsThe study commenced across 2013 and 2014 and involved volunteers from the Jidong (East Hebei) district. A cohort of 2,482 participants aged 45 years or older were randomly selected, of which 49.9% were women and none were diagnosed as having cancer, stroke, or heart diseases such as atrial fibrillation, heart failure, or myocardial infarction. The study collected information concerning seven CVH metrics; namely body mass index, dietary intake, smoking, blood pressure, physical activity, total cholesterol, and fasting blood glucose, and evaluated EATV based on computed tomography. Finally, an analysis of the relationship between ideal CVH metrics and the prevalence of high EATV was made applying multiple logistic regression.ResultsOn the basis that age, gender, and other potential confounding factors are adjusted, comparing the participants having an ideal CVH index of 2, 3, 4, 5 and 6-7 with those having a 0-1 metric, the adjusted odds ratios (95% confidence interval) of high EATV were as follows: 0.893 (0.468-1.705), 0.581 (0.316-1.069), 0.368 (0.202-0.670), 0.218 (0.119-0.400), and 0.161 (0.085-0.306) (P trend less than 0.0001). Similar negative correlations were also seen in other cases of different age groups and gender groups, where all P trends were less than 0.0001.ConclusionsThe number of ideal CVH metrics in the northern Chinese population is negatively correlated with the prevalence of high EATV, supporting the greater use of EATV as a useful parameter in clinical practice.

Project description:BackgroundInappropriate medical treatment of co-morbidities in Alzheimer's disease (AD) is an increasing concern in geriatric medicine. The objective of this study was to compare current drug use related to co-morbidity between individuals with a recent diagnosis of AD and a cognitively healthy control group in a population based clinical trial in Northern Norway.MethodsSettingNine rural municipalities with 70,000 inhabitants in Northern Norway.ParticipantsPARTICIPANTS with and without AD recruited in general practice and by population based screening.187 participants with a recent diagnosis of AD were recruited among community dwellers. Of 791 respondents without cognitive symptoms, 500 were randomly selected and invited to further clinical and cognitive testing. The final control group consisted of 200 cognitively healthy individuals from the same municipalities. Demographic characteristics, data on medical history and current medication were included, and a physical and cognitive examination was performed. The statistical analyses were carried out by independent sample t-test, chi-square, ANCOVA and logistic regression.ResultsA co-morbidity score was significantly higher in AD participants compared to controls. The mean number of drugs was higher for AD participants compared to controls (5.1±3.6 and 2.9±2.4 respectively, p<0.001 age and gender adjusted), also when adjusted for co-morbidity. AD participants used significantly more anticholinergic, sedative and antidepressant drugs. For nursing home residents with AD the mean number of drugs was significantly higher compared to AD participants living at home (6.9±3.9 and 4.5±3.3, respectively, p<0.001).ConclusionsAD participants were treated with a significantly higher number of drugs as compared to cognitively healthy controls, even after adjustment for co-morbidity. An inappropriate use of anticholinergic and sedative drugs was identified, especially among nursing home residents with AD. The drug burden and the increased risk of adverse reactions among individuals suffering from AD need more attention from prescribing doctors.

Dataset Information

Marginalisation and cardiovascular disease among rural Sami in Northern Norway: a population-based cross-sectional study.

Background

Methods

Results

Conclusions

Publications

Marginalisation and cardiovascular disease among rural Sami in Northern Norway: a population-based cross-sectional study.

Similar Datasets

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