Internal Medicine Department, Universidad Nacional Pedro Henriquez Ureña (UNPHU), Santo Domingo, Dominican Republic.
BMC Public Health. 2010 Jun 16;10:344. doi: 10.1186/1471-2458-10-344.
Very little of the increased attention towards chronic diseases in countries with low and middle incomes has been directed towards older people, who contribute 72% of all deaths, and 14% of all Disability Adjusted Life Years linked to this group of conditions in those regions. We aimed to study the prevalence of physical, mental and cognitive diseases and impairments among older people in the Dominican Republic, their social patterning, and their relative contributions to disability.
A cross-sectional catchment area one-phase survey of chronic disease diagnoses, physical impairments, risk factors and associated disability among 2011 people aged 65 years and over (of whom 1451 gave fasting blood samples) in Santo Domingo, Dominican Republic.
The most prevalent diagnoses were hypertension (73.0%), anaemia (35.0%), diabetes (17.5%), depression (13.8%) and dementia (11.7%), with 39.6% meeting criteria for metabolic syndrome. After direct standardization (for age and sex) the prevalences of stroke (standardized morbidity ratio [SMR] 100) and hypertension (SMR 108) were similar to those in the United States of America National Health and Nutrition Examination Survey (NHANES reference SMR 100), while those of diabetes (SMR 83) and metabolic syndrome (SMR 72) were somewhat lower. Anaemia was three times more common than in the USA (SMR 310). Diabetes, hypertension, dyslipidaemia, obesity and the metabolic syndrome were associated with affluence and female sex. Arthritis, anaemia, dementia and stroke were strongly age-associated and these conditions were also the main independent contributors to disability.
The prevalence of many chronic diseases is similar in predominately low socioeconomic status neighbourhoods in the Dominican Republic to that in the USA. Prevalence of age-associated conditions is likely to increase with demographic ageing. There is also scope for increases in cardiovascular disease prevalence, if, as observed in other settings undergoing the epidemiologic transition, the burden of risk factors shifts towards the less affluent. Monitoring future trends in the prevalence and social patterning of chronic diseases may help to assess the effectiveness and equity of primary and secondary prevention strategies. Specific recommendations from our research include identifying and targeting the causes of anaemia among older people, and addressing women's health disadvantages.
在中低收入国家，人们对慢性病的关注度虽然有所增加，但却很少关注老年人。在这些地区，老年人占所有死亡人数的 72%，占与这组疾病相关的所有残疾调整生命年数的 14%。我们旨在研究多米尼加共和国老年人中身体、精神和认知疾病及障碍的流行情况、其社会模式，以及它们对残疾的相对影响。
在多米尼加共和国圣多明各进行了一项横断面、集水区、单阶段的慢性病诊断、身体障碍、危险因素以及与 2011 名年龄在 65 岁及以上人群（其中 1451 人接受了空腹血样检测）相关的残疾情况调查。
最常见的诊断是高血压（73.0%）、贫血（35.0%）、糖尿病（17.5%）、抑郁症（13.8%）和痴呆症（11.7%），有 39.6%的人符合代谢综合征的标准。经直接标准化（按年龄和性别）后，中风的发病率（标准化发病比 [SMR] 100）和高血压（SMR 108）与美国国家健康和营养检查调查（NHANES 参考 SMR 100）相似，而糖尿病（SMR 83）和代谢综合征（SMR 72）的发病率则略低。贫血的发病率是美国的三倍（SMR 310）。糖尿病、高血压、血脂异常、肥胖和代谢综合征与富裕和女性有关。关节炎、贫血、痴呆和中风与年龄密切相关，这些疾病也是导致残疾的主要独立因素。
在多米尼加共和国以社会经济地位较低为主的社区中，许多慢性病的流行情况与美国相似。随着人口老龄化，与年龄相关的疾病的流行率可能会增加。如果像在其他经历流行病学转变的环境中观察到的那样，危险因素负担向较不富裕的人群转移，那么心血管疾病的流行率也有可能增加。监测慢性病的流行趋势和社会模式的变化，有助于评估初级和二级预防策略的有效性和公平性。我们的研究提出了一些具体建议，包括确定和解决老年人贫血的原因，并解决妇女健康方面的劣势。
