Psihosocijalne karakteristike kao čimbenici rizika u hospitaliziranih koronarnih bolesnika u Hrvatskoj

Šikić Vagić, Jozica (2010) Psihosocijalne karakteristike kao čimbenici rizika u hospitaliziranih koronarnih bolesnika u Hrvatskoj. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Patients are hospitalized for coronary illness on average at 63 years of age, men at 61 and women seven years later at 68, regardless of whether they have acute or chronic coronary illness and regardless which region they live in (p<0.001). The relative risk for hospitalization for acute coronary illness is twice as high in Mediterranean Croatia as it is in continental Croatia (RR 1.98, 95% CI1.58-2.48, p<0.001). The waist-to-hip ratio patients hospitalized with coronary illness in Croatia is around 1 in male patients, and 0.93 in female patients. In continental Croatia the average waist-to-hip ratio for women is 0.95, and in Mediterranean Croatia 0.91. There was no significant difference in body mass index (BMI) between men in continental Croatia (28.27 kg/m2) and men in Mediterranean Croatia (27.93 kg/m2), as there was not in regard to acute or chronic coronary illness. Patients hospitalized for coronary illness have a higher BMI in the continental part of Croatia, ITM 29.17 kg/m2: 27.03 kg/m2 (p<0.0001). Dried meat products increase the relative risk of hospitalization for acute coronary illness by two times, skimmed milk by 1.24 times (46%), whole milk by 1.45 times (45%) and olive oil by 68%. Fruit reduces the relative risk of hospitalization for acute coronary illness by 44% (OR 0.56, 95% CI 0.33-0.95, p=0.0321), and the taking of statins reduces it by 54% (OR=0.46, 95%CI 0.35-0.60, p<0.001). There is no significant difference in dietary habits (healthy: continental diet) between the Mediterranean and continental parts of Croatia, nor is there in diet quality between men and women, although women tend towards a healthier diet. There is no difference in men's and women's income based on region or acute or chronic coronary illness. Female subjects surveyed in the continental part of Croatia had the lowest income, with 19.25% of them having a monthly income lower than 2,000 kn. There is no statistically significant difference in BMI in men and women related to level of education, although there is a tendency towards lower BMI as level of education increases (28.04:27.96:27.80 in men, and 28.76:28.07:28.21 in women). Men and women with a higher level of education have a healthier diet and lower cholesterol (men 5.4:5.4:5.0 and women 5.4:5.5:4.9 mmol/l). Smoking and alcohol consumption in both men and women are inversely related to level of education. Men and women with a higher level of education pay more attention to physical activities. In all categories, women are less physically active than men. Male patients with coronary illness are more educated than the general population in Croatia (23.40%:32.2% have elementary education; 55,77%:55% have secondary education; and 20.83%:12.8% have higher education). The case is similar in patients with coronary illness (48.3%:46.72%; 40.5%:43.17%; 11.2%:10.11%). 58.21% of male patients with coronary illness are blue collar workers, while 41.79% of them are white collar workers. Blue collar worker have a 22% lower relative risk of hospitalization for acute coronary illness in relation to white collar workers (RR=0,78,95%, CI 0,61-0,99, p=0,0382). 12.19% of patients have work-related stress as a potential risk factor in coronary illness. 15% of male patients in continental Croatia have work-related stress related to failure or loss of work, while this relates 8.7% of male patients in Mediterranean Croatia. 18% of patients hospitalized for acute coronary illness in continental Croatia suffer from work-related stress, while this number in Mediterranean Croatia is 9%. 7.73% of patients suffer from work-related stress, and there is no significant difference in relation to acute or chronic illness by region. Hospitalized patients with coronary illness are mainly satisfied with the surroundings in which they live with over 95% of them listing it as comfortable, so that this cannot be separated as a potential risk factor for coronary illness in neither men nor women. According to the SF-36 results, subjects surveyed with coronary illness feel worse compared to the general population in all parameters in which they rate their physical and mental status compared to the general population (p<0.05). The health of 70.3% of subjects surveyed worsened within the last year, while only 1.6% of sufferers felt much better. Physical and mental condition is better in men in all tested variables of survey SE-35 in comparison to women. The lowest difference is in the rating of one's own mental condition (3.22). There was a small difference in variables which demanded a positive answer in order to provide a good result (strength, vitality 6.3; consideration of general health 5.99 and mental condition 3.22). Conclusion: Considering environment, there is no significant difference between the sexes with regard to acute and chronic coronary illness in either region. Family- and work-related stress as a potential risk factor is more present in men in the continental region compared to the Mediterranean region. The socioeconomic pattern follows the characteristics of the general population in Croatia. Coronary disease sufferers, both men and women, are more educated than the general population. Coronary disease sufferers feel worse than the general population according to all parameters of survey SF-36. The smallest difference is in mental condition. Men feel better than women by all parameters. The healthy Mediterranean diet loses its historical difference according to region.

Abstract in Croatian

Bolesnici zbog koronarne bolesti se prosječno hospitaliziraju u 63 godini života, muškarci u 61. godini života a u žena sedam godina kasnije, u 68. godini života neovisno o tome imaju li akutnu ili kroničnu koronarnu bolest i kojoj regiji pripadaju (p<0,001). Omjer šansi rizika za hospitalizaciju od akutne koronarne bolesti je dva puta veći u mediteranskoj Hrvatskoj u odnosu na kontinentalnu (OR 1,98, 95% CI1,58-2,48, p<0,001). Omjer struka i bokova u hospitaliziranih bolesnika s koronarnom bolesti u Hrvatskoj je oko 1, a u bolesnica 0,93. U kontinentalnoj Hrvatskoj prosječni omjer struka i bokova u žena je 0,95 a u mediteranskoj 0,91. U Indeksu tjelesne mase (ITM) muškaraca u kontinentalnoj (28,27 kg/m2) i mediteranskoj (27,93 kg/m2) Hrvatskoj nije bilo značajne razlike, također niti s obzirom na akutnu ili kroničnu koronarnu bolest. Hospitalizirane koronarne bolesnice imaju veći ITM u kontinentalnom dijelu Hrvatske, ITM 29,17 kg/m2: 27,03 kg/m2 (p<0,0001). Razlika među regijama je najveća u bolesnica s akutnom koronarnom bolešću (kontinentalna 30,33 kg/m2 : mediteranska 26,6 kg/m2), (p<0,0001). Suhomesnati proizvodi povećavaju omjer šansi rizika za hospitalizaciju zbog akutne koronarne bolesti 2 puta, obrano mlijeko 1,24, odnosno 46%, punomasno 1,45 puta, odnosno 45% a maslinovo ulje 68%. Voće smanjuje omjer šansi rizika za hospitalizaciju zbog akutne koronarne bolesti 44% (OR 0,56, 95% CI 0,33-0,95, p=0,0321), a uzimanje statina 54 % (OR=0,46, 95%CI 0,35-0,60, p<0,001. Nema značajne razlike u prehrambenim navikama (zdrava:kontinentalna prehrana) između mediteranskog i kontinentalnog dijela Hrvatske, niti u kvaliteti prehrane između muškaraca i žena, iako žene imaju tendenciju zdravijoj prehrani. Nema razlike u visini prihoda u muškaraca i žena s obzirom na regije te akutnu ili kroničnu koronarnu bolesti. Muškarci u obje regije u prosjeku imaju veću plaću u odnosu na žene. Najniže prihode imaju ispitanice u kontinentalnom dijelu Hrvatske, njih 19,25% ima prihode manje od 2000 kn. Nema statistički značajne razlike u ITM u muškaraca i žena s obzirom na stupanj edukacije iako postoji tendencija smanjenja ITM porastom stručne spreme (28,04:27.96:27,80 u muškaraca, te 28,76:28,07:28,21 u žena). Educiraniji muškarci i žene se zdravije hrane i imaju nižu razinu kolesterola (muškarci 5,4:5,4:5,0, a žene 5,4:5,5,4,9 mmol/l). Pušenje i konzumacija alkohola su i kod muškaraca i kod žena obrnuto povezani sa stručnom spremom. Educiraniji muškarci i žene više pažnje poklanjaju fizičkoj aktivnosti. U svim kategorijama žene su manje fizički aktivne u odnosu na muškarce. Muškarci, s koronarnom bolešću su obrazovaniji u odnosu na opću populaciju u Hrvatskoj, (osnovno obrazovanje ima 23,40%:32,2%, srednjoškolsko 55,77%:55%, a fakultetsko 20,83%:12,8%). Slično je i u bolesnica s koronarnom bolešću (48,3%:46,72%; 40,5%:43,17%, 11,2%:10,11%). 58,21% bolesnika s koronarnom bolešću su manuelni radnici a nemanuelnih je 41,79 %. Manuleni radnik ima 22% manji omjer šansi rizika za hospitalizaciju zbog akutne koronarne bolesti u odnosu na nemanuelnog radnika (OR=0,78,95%,CI0,61-0,99,p=0,0382). Poslovni stres kao mogući čimbenik rizika koronarne bolesti ima 12,19 % bolesnika. 15% muškaraca u kontinentalnoj Hrvatskoj ima poslovni stres u vidu neuspjeha ili gubitka posla dok u mediteranskoj 8,7% bolesnika. 18 % bolesnika hospitaliziranih zbog akutne koronarne bolesti u kontinentalnoj Hrvatskoj ima poslovni stres a u mediteranskoj Hrvatskoj 9%. 7,73% bolesnica ima poslovni stres, i nema značajnih razlika s obzirom na akutnu ili kroničnu bolest i prema regiji. Hospitalizirani bolesnici s koronarnom bolesti su uglavnom zadovoljni okruženjem u kojem žive, u preko 95% ga navode kao ugodno, tako da se ne može izdvojiti kao mogući čimbenik rizika koronarne bolesti niti u muškaraca niti u žena. Prema rezultatima SF-36 ispitanici s koronarnom bolešću u odnosu na opću populaciju u Hrvatskoj se lošije osjećaju u svim parametrima koji ocjenjuju fizički i psihički status (p<0,05). Zdravstveno stanje se pogoršalo u zadnjih godinu dana u 70,3% ispitanika, samo se 1,6% bolesnika osjećalo puno bolje. Kvaliteta psihičkog i fizičkog statusa je bolja u muškaraca u svim ispitivanim varijablama upitnika SF-36 u odnosu na žene. Najmanja razlika je u ocjeni vlastitog psihičkog stanja (3,22). Mala razlika je bila i u varijablama koje zahtijevaju pozitivan stav da bi se dobio dobar rezultat (snaga, vitalnost 6,3; opće poimanje zdravlja 5,99 te psihičko stanje 3,22). Zaključak: Okruženje se ne može izdvojiti kao čimbenik rizika koronarne bolesti. Obiteljski i poslovni stres kao mogući čimbenik rizika je više prisutan u muškaraca u kontinentalnoj u odnosu na mediteransku regiju. Socioekonomski uzorak slijedi karakteristike opće populacije u Hrvatskoj. Bolesnici s koronarnom bolešću (muškarci i žene), su obrazovaniji u odnosu na opću populaciju. Bolesnici s koronarnom bolesti se prema svim parametrima upitnika SF-36 lošije osjećaju u odnosu na opću populaciju. Najmanja razlika je u psihičkom statusu. Muškarci se u svim parametrima bolje osjećaju u odnosu na žene. Zdrava, mediteranska, prehrana gubi svoju povijesnu razliku s obzirom na regije.

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