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Cancer-related mortality in Peru: Trends from 2003 to 2016

Objectives
In the last decade, Latin American (LA) countries, like Peru, have undergone an epidemiological transition that has changed the pattern of oncological cases. Given that Peru’s oncological pattern could illustrate those of other LA countries, we aimed at determining trends and changes in cancer-related mortality by age and sex in Peru between 2003 and 2016.

METHODS:
A secondary data analysis using national deaths registries was conducted. Categories were created according to the 27 most frequent sites of presentation of cancer. We found that
deaths attributed to cancer increased from 15.4% of all deaths in 2003 to 18.1% in 2016 (p<0.001). According to the cancer site, stomach cancer (19.1%) and lung cancer (11.5%) were the most frequent causes of death overall. In childhood (0 to 14 years), the two most frequent fatal cancers were leukemia (54.6% for boys and 53.5% for girls) and brain and nervous system tumors (19.4% for boys and 20.3% for girls). For teenagers and young male adults (15–49 years), stomach cancer (18.1%) and brain cancer (17.4%) were the leading causes of death; in their female counterparts, cervix uteri (20.0%) and breast cancer (16.1%) were the most mortal cancers. In adults (�50 years), stomach (20.9% for men and 18.6% for women) and lung (12.7% for men and 10.4% for women) were the leading contributors to the burden of cancer deaths. Conclusions Between the years 2003 and 2016, almost one fifth of deaths were attributed to cancer in Peru. Absolute and relative number of deaths due to cancer has increased in this period for both men and women; however, standardized mortality rates due to cancer have declined

The Effect of a Priest-Led Intervention on the Choice and Preference of Soda Beverages: A Cluster-Randomized Controlled Trial in Catholic Parishes

BACKGROND:
Latin America ranks among the regions with the highest level of intake of sugary beverages in the world. Innovative strategies to reduce the consumption of sugary drinks are necessary.

METHODS:
We conducted a pragmatic cluster-randomized trial in Catholic parishes, paired by number of attendees,in Chimbote, Peru between March and June of 2017. The priest-led intervention, a short message about the importance of protecting one’s health, was delivered during the mass. The primary outcome was the proportion of individuals that choose a bottle of soda instead of a bottle of water immediately after the service. Cluster-level estimates were used to compare primary and secondary outcomes between intervention and control groups utilizing nonparametric tests.

RESULTS:
Six parishes were allocated to control and six to the intervention group. The proportion of soda selection at baseline was ~60% in the intervention and control groups, and ranged from 56.3% to 63.8% in Week 1, and from 62.7% to 68.2% in Week 3. The proportion of mass attendees choosing water over soda was better in the priest-led intervention group: 8.2% higher at Week 1 (95% confidence interval 1.7%–14.6%, p = .03), and 6.2% higher at 3 weeks after baseline (p = .15).

CONCLUSIONS:
This study supports the proof-of-concept that a brief priest-led intervention can decrease sugary drink choice.

Inequalities in life expectancy in six large Latin American cities from the SALURBAL study: an ecological analysis

BACKGROUND:
Latin America is one of the most unequal regions in the world, but evidence is lacking on the magnitude of health inequalities in urban areas of the region. Our objective was to examine inequalities in life expectancy in six large Latin American cities and its association with a measure of area-level socioeconomic status.

METHODS:
In this ecological analysis, we used data from the Salud Urbana en America Latina (SALURBAL) study on six large cities in Latin America (Buenos Aires, Argentina; Belo Horizonte, Brazil; Santiago, Chile; San José, Costa Rica; Mexico City, Mexico; and Panama City, Panama), comprising 266 subcity units, for the period 2011–15 (expect for Panama city, which was for 2012–16). We calculated average life expectancy at birth by sex and subcity unit with life tables using age-specific mortality rates estimated from a Bayesian model, and calculated the difference between the ninth and first decile of life expectancy at birth (P90–P10 gap) across subcity units in cities. We also analysed the association between life expectancy at birth and socioeconomic status at the subcity-unit level, using education as a proxy for socioeconomic status, and whether any geographical patterns existed in cities between subcity units.

FINDINGS:
We found large spatial differences in average life expectancy at birth in Latin American cities, with the largest P90–P10 gaps observed in Panama City (9·8 years for men and 11·2 years for women),Santiago (8·9 years for me and 17·7 years for women), and Mexico City (10·9 years for men and 9·4 years for women), and the narrowest in Buenos Aires (4·4 years for men and 5·8 years for women), Belo Horizonte (4·0 years for men and 6·5 years for women), and San José (3·9 years for men and 3·0 years for women). Higher area-level socioeconomic status was associated with higher life expectancy, especially in Santiago (change in life expectancy per P90–P10 change unit-level of educational attainment 8·0 years [95% CI 5·8–10·3] for men and 11·8 years [7·1–16·4] for women) and Panama City (8·0 years [4·4–11·6] for men and 10·0 years [4·2–15·8] for women). We saw an increase in life expectancy at birth from east to west in Panama City and from north to south in core Mexico City, and a core-periphery divide in Buenos Aires and Santiago. Whereas for San José the central part of the city had the lowest life expectancy and in Belo Horizonte the central part of the city had the highest life expectancy.

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