High Socioeconomic Research Articles

Abstract 3673: Socioeconomic disparities and the genomic landscape of gastric cancer

Abstract Background: Gastric cancer is a malignancy of diverse etiology and exposition to risk factors may vary in distinct socioeconomic (SE) groups. Our aim was to compare the landscape of genomic alterations in malignant gastric tumors between different socioeconomic groups in Peru. Methods: We conducted a preliminary prospective study in one private clinic and two public hospitals in Lima and Ica (Peru). We evaluated 20 patients with gastric carcinomas, 10 of which were classified as low SE status (LSE) and 10 as medium/high SE status (MHSE), according to the Peruvian Association of Market Intelligence Companies (APEIM) classification system. We conducted a comprehensive genomic profiling of gastric tumors with the FoundationOne CDx platform. We compared rates of alterations in single nucleotide variants, copy number variations, tumor mutation burden, microsatellite instability, and pathways altered. Results: In our cohort, the mean age at diagnosis was 67.5 yo vs 61 yo, while 40% vs 55.6% were male patients, for LSE vs MHSE, respectively. We found alterations in driver genes in 19 patients (10 LSE and 9 MHSE). Histological analysis of the tumor samples revealed a higher proportion of intestinal histology in the LSE group (80%) compared to MHSE (55.6%). On the other hand, the diffuse subtype pattern was more prevalent in the MHSE group (33%) compared to LSE (20%). One case of mixed histology was observed in the high SE group. Both LSE and HMSE showed a similar distribution of Bormann Classification/type, where most of the samples were of class III/IV (75%) followed by class I/II (25%). Furthermore, genomic profiling analysis showed 45 driver alterations in LSE, while only 25 alterations were detected in MHSE. the most frequently altered genes were TP53 and KRAS in both SE groups, but with a higher incidence in LSE (60% and 20%, respectively). Components of the MAPK pathway were altered in 50% vs 33.3%, while the DNA repair pathway was altered in 20% vs 11%, in LSE vs MHSE, respectively. The PI3K/Akt pathway was altered in only one case of LSE. Median of tumor mutation burden was 6.1Mut/Mb in LSE vs 5.3Mut/Mb MHSE. Only one case with microsatellite instability was found in LSE. Conclusions: Despite the limitations of this preliminary study, we observed some differences in the genomic background between patients from different socioeconomic groups. Therefore, the need of a thorough diagnosis approach that leads to the use of a comprehensive treatment that includes targeted therapy and immunotherapy could be different based on the SE status of the patient. Further research on this topic will be necessary. Citation Format: Daniel Zanabria, Marco Galvez-Nino, Cristina Eunbee Cho, Williams Fajardo, Luis Saravia, Jhajaira Araujo, Alejandro Alfaro, Lidia Quispe, Melanie Cornejo, Paula Medina, Junior Carbajal, Paola Montenegro, Alejandra Zevallos, Alfredo Aguilar, Joseph A. Pinto. Socioeconomic disparities and the genomic landscape of gastric cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3673.

Socio-economic determinants of healthy behaviours among primary schoolchildren and adolescents in Lokossa district of southern Benin.

There is little information regarding fruit and vegetable (FV) intake and physical activity (PA) among schoolchildren in Benin. In this study we evaluated the differences in breakfast eating, FV consumption and PA according to socio-economic (SE) determinants in primary schoolchildren. A cross-sectional study using a probabilistic sample of 612 students (8-17y of age) from 26 primary schools was done between December 2018 and January 2019. The association was estimated by logistic regression analyses. Of all students, 53% were physically inactive, 60% took breakfast <5d/week, 84% irregularly ate fruits and 68% irregularly ate vegetables. Younger students (8-10y) take breakfast regularly and older ones (>15y) were physically more active. The probability of regular breakfast and fruit consumption were significantly higher in children of educated parents (p<0.01 and p<0.001, respectively) compared with children of non-educated parents. Medium SE status was associated with regular breakfast intake, whereas high SE status was associated with higher fruit intake and lower physical activity compared with low SE status (p<0.001). There was no association between breakfast eating, FV intake, PA and the body mass index. Findings emphasize the need for interventions to promote healthy eating behaviours in primary schoolchildren and their family environments.

Access to Healthy Wheat and Maize Processed Foods in Mexico City: Comparisons across Socioeconomic Areas and Store Types.

The contributions of processed foods to the overweight and obesity problem in Latin America are well known. Engagement with the private and public sectors on possible solutions requires deeper insights into where and how these products are sold and the related implications for diet quality. This article characterizes the diversity of wheat and maize processed foods (WMPFs) available to consumers in Mexico City. Data were gathered across nine product categories at different points of sale (supermarkets, small grocery stores, convenience stores) in high and low socioeconomic (SE) areas. We assessed WMPFs based on Nutri-Score profile, price, and health and nutrition claims. Roughly 17.4% of the WMPFs were considered healthy, of which 62.2% were pastas and breads. Availability of healthy WMPFs was scarce in most stores, particularly in convenience stores Compared to supermarkets in the low SE area, those in the high SE area exhibited greater variety in access to healthy WMPFs across all product categories. In the low SE area, healthy WMPFs were priced 16–69% lower than unhealthy WMPFs across product categories. The extensive variety of unhealthy WMPFs, the limited stock of healthy WMPFs in most retail outlets, and the confusing health and nutrition claims on packaging make it difficult for urban consumers to find and choose healthy WMPFs.

Resting EEG, Hair Cortisol and Cognitive Performance in Healthy Older People with Different Perceived Socioeconomic Status.

Successful aging depends upon several internal and external factors that influence the overall aging process. Objective and subjective socioeconomic status emerge as potential psychosocial factors in the ethiopathophysiology of aging-related disorders. Presumably, low socioeconomic status can act as a psychosocial stressor that can affect humans’ physiology via psychoneuroendocrine mechanisms, that may, in turn, affect the brain physiology. In resting-state electroencephalography (EEG), excess theta and delta activity has been related to cognitive decline and dementia. The main aim of this study was to analyze the effect of objective and subjective socioeconomic status (SES) on cognition and brain electrical activity through EEG measures. The present research constitutes a cross-sectional study with thirty healthy older adults (61–82 years old) separated into two clusters: high socioeconomic (HS) and low socioeconomic (LS) status; they were evaluated and compared in cognitive terms using the Wechsler Adult Intelligence Scale (WAIS-IV). An EEG at rest was recorded to measure brain activity and, as an indicator of long-term stress exposure, hair cortisol concentrations (HCC) were measured. Our results show that lower SES is related to a worse performance in working memory tasks (p = 0.009), higher delta (p = 0.002) and theta power (p = 0.039), and lower alpha activity (p = 0.028). However, it seems that SES does not significantly affect HCC in this population of healthy older adults. The effects of SES on long-term cortisol exposure, brain electrical activity, and cognitive functions in healthy older people emphasize the role of psychosocial factors in aging from an integrative perspective that will allow us to implement better prevention programs to target cognitive decline in adults.

1673. Gendered Patterns of HIV, TB, and Other Primary Care Referrals in Rural South Africa

BackgroundMen’s lack of engagement in healthcare hinders HIV efforts in sub-Saharan Africa. Masculine norms and lack of accessibility in a female-dominated healthcare system deter male health-seeking behavior. Community interventions combat the gender gap. In South Africa (SA), alcohol-based venues (ABV) are common locales for men. We created an ABV community health screening to determine the need.MethodsCommunity Health Workers targeted ABV in rural SA, offering screenings for HIV, TB, Isoniazid Preventive Therapy, STI, hypertension, diabetes, circumcision, with referral to primary care services (PCS) for any positive screenings. Participants completed questionnaires, including socioeconomic (SE), healthcare use, and alcohol use evaluated by AUDIT scores. Multivariable logistic regression identified factors associated with referral to PCS.ResultsFrom July 2018 to March 2019, 1356 were screened, 74% were men, median age was 30 (IQR 22–46), 26% employed and 30% had running water. Men are more likely to have never gone to a PCS compared with women (15.9% vs. 9.7%, P = 0.004) and have lengthier time since the last clinic visit (1.4 years vs. 0.6 years, P < 0.001). Men are significantly more likely than women to report hazardous drinking (49% vs. 28%, P < 0.001) Overall, positive screenings were noted in 537 (53.9%) community members, and χ 2 analysis show men more likely to require referrals after screening (P = 0.08). Multivariate analysis shows among men, referrals were associated with older age, hazardous drinking, any health concerns; while higher SE was protective. For women, only age and health concerns were associated with referral. Similarly, alcohol contributed to HIV and TB referrals for men, while higher SE was protective of TB referrals for men (Table 1).ConclusionABV males in this rural community, although disengaged from health care, required more referrals than women. HIV, TB, and any referrals for men screened at ABV in rural SA were associated with lower SE and hazardous drinking, highlighting the challenges that this population faces in seeking health care. Differentiated and targeted community-based services may facilitate care for these hard to reach men in sub-Saharan Africa. Next steps include determining clinical outcomes of referrals. Disclosures All authors: No reported disclosures.

Can the socio-economic status of young children influence their language performance? An Indian study

Background: Language development during early childhood is crucial to a child’s overall development. The socioeconomic status (SES) is a major contributing factor to development, whose impact on language is less explored in young children especially in a multicultural country like India. This research focussed on assessing the semantic language of children from lower socio-economic (LSE) and higher socio-economic (HSE) status. Method: Sixty typically-developing Kannada speaking children between 2 and 5 years of age were classified into 3 groups (Group I: 2.0 – 2.11, Group II: 3.0 – 3.11, and Group III: 4.0 – 4.11 years), with each group being further divided into HSE and LSE subgroups. Language samples were collected using a picture description task and were analyzed for the semantic (total number of words and different words-TTR) measures. Descriptive statistics was done to determine mean and SD of both measures for each of the participants of the HSE and LSE subgroups. Nonparametric tests determined the level of significance between and across the HSE and LSE subgroups (between each of the 3 groups). Results: The results indicated a significant difference (p<0.05) across the HSE (I-HSE, II-HSE, and II-HSE) and LSE (I-LSE, II-LSE, and III-LSE) subgroups for the semantic measures. Comparison between the HSE and LSE subgroups indicated a significant difference (p<0.05) only between the 3 year-olds. Conclusion: These findings provide an insight into how early and to what extent SES impacts language development in 2, 3, and 4 year-old children.

Abstract 148: Association of Socioeconomic Context With Blood Pressure Response and Cardiovascular Outcomes in ALLHAT

Introduction: Observational studies demonstrate that in low socioeconomic (SE) communities, where residents face social challenges and fewer opportunities for healthy lifestyle behaviors or quality care, blood pressure (BP) is higher and there are worse cardiovascular (CV) outcomes. Yet whether the effectiveness of antihypertensive therapy on BP control and CV outcomes varies by SE context in a randomized clinical trial (RCT) - where patients are treated under a standard protocol - is unknown. Methods: We used data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), which randomized 42,418 people with hypertension (HTN) to chlorthalidone, lisinopril, amlodipine or doxazosin. After excluding non-continental US sites and the doxazosin arm (terminated early), our study included 27,862 participants. We defined SE context by mapping study site ZIP codes to counties and stratifying these into income quintiles based on the national distribution of cost-of-living adjusted county median household income (2000 US Census). We compared characteristics and outcomes between participants in the lowest and highest SE quintiles using multivariable regression models. We replicated the analysis with black participants (n = 10532). Results: Participants enrolled in low SE sites (n = 2169, 7.8%) were more likely to be female, black, Hispanic, less educated, live in the South, and have fewer CV risk factors than participants in high SE sites (n = 10458, 37.6%). Participants in low SE sites were less likely to achieve BP control (&lt;140/90 mmHg) at 6 years (OR 0.48, 95% CI [0.37, 0.63]). They had higher all-cause mortality (HR 1.25, 95% CI [1.10, 1.41]) and heart failure hospitalization/mortality (HR 1.26, 95% CI [1.03, 1.55]), though lower angina hospitalization (HR 0.70, 95% CI [0.59, 0.83]) and coronary revascularization (HR 0.71, 95% CI [0.57, 0.89]) and no differences in stroke or MI. Results were similar among black participants. Conclusion: Despite having access to extra resources afforded by an RCT, ALLHAT participants in low SE sites had poorer BP control, higher mortality and greater heart failure morbidity. Our findings suggest a need to address the SE context beyond the medical environment to attain equity in HTN outcomes.

Malnutrition among Children under 5 Does Not Correlate with Higher Socio Economic Status of Parents in Rural Communities

Introduction: Understanding the socioeconomic characteristics of families with undernourished children is very critical to providing solution to the menace especially in rural communities where there is complexity in the relationship between economic activities, education and parental care and the undernutrition. Objectives: The study is aimed at understanding the nutritional status of children under the age of 5 years in relation to the socio economic status of the family so as to determine causes of vulnerability. Methods: Hospital based cross sectional study was carried among 505 children under the age of 5 years, taking measurement of their Mid Upper Arm Circumference (MUAC) using standard techniques and also taking records of their families’ socioeconomic data using structured questionnaire. Results: Record of nutritional status of the children sampled shows that undernourished children were 345 (68.3%) and the nourished were 160 (31.7%). The number of times each child felt sick within the last one year shows that out of the total 505 children, 140 (27.72%) fell sick once, 155 (30.69%) fall sick twice in the previous year, 65 (12.87%) felt sick three times, 55 (10.89%) felt sick four times due to either malaria, undernutrition or other factors. Children born to farmers, constituting 51.5% of the sampled children have as high as 69.2% prevalence of undernutrition, compared to those born to beggars (0%). The highest prevalence is recorded in children born to petty traders (80%), followed by government workers and commercial motorcyclist with 75% each. Prevalence of 100% was recorded in the sampled children whose father attains tertiary level of education, followed by those who attain only secondary level of education (68%). Conclusion: There is high prevalence of undernutrition among children in rural communities which is often underestimated for the fact that rural dwellers of Kano are mostly farmers and that they are adequate to provide for their children. Frequency of illnesses among the children of rural dwellers is associated with the nutritional status of the children. Malnutrition is not always dependent on the occupation and educational status of the parents or whether child parents are alive or not. Children of farmers and learned persons are also very susceptible to malnutrition in the rural communities of Kano. Nutritional education and programs should as well target all families with varied socioeconomic status, including farmers, petty traders and those with high educational status without making assumptions that they are less susceptible to malnutrition.

Sociobehavioural risk factors of dental caries among selected adolescents in Ibadan, Nigeria

ObjectiveThe objective of this study was to determine the influence of sociodemographic and behavioural factors on the prevalence of dental caries among the adolescents in Ibadan. MethodMultistage sampling method was used to select participants from six secondary schools. In each school, an arm was selected randomly from each class and 30 students also randomly chosen per arm, with equal distribution of males and females. A structured questionnaire was administered. It consisted two parts, the first part assessed information on the sociodemographic characteristics, oral health behaviours and snacking habits of respondents, while the second part consisted of intra-oral examination to determine the caries status and oral hygiene (OH) levels of respondents. ResultThe age range of the participants was 10–19 years with a mean of 13.73 ± 2.02 years. The father's level of education had a statistically significant association with dental caries; prevalence of dental caries was high in the 10–14-years age group, in children of parents from high socio-economic (SE) class, those who reported brushing twice daily, those with poor OH and those who ate snacks in between their meals. ConclusionThis study reveals that high SE status, poor OH and daily consumption of biscuits were important factors in caries experience among the school children studied.

Evolution of socioeconomic inequality in smoking behavior in Portugal: 1987-2006

Background In countries where prevalence of smoking is higher among the worse-off, tobacco consumption contributes to socioeconomic (SE) inequalities in health. Southern European countries, however, have traditionally been characterized by a higher prevalence of smoking among high SE groups. We investigated whether this traditional pattern still applied to Portugal by describing the evolution of SE inequalities in smoking between 1987 and 2006. Methods We used data from the 4 National …

Influence of micronutrient status and socioeconomic gradient on growth indices of 2–18-year-old Indian girls

Micronutrient deficiencies are common consequences of the plant-based diet in children from developing countries which may affect their linear and ponderal growth. The aim of the study was to investigate the association between micronutrient status and growth indices in Indian girls. In cross-sectional studies (2006-2010), data on weight, height and diet were collected on 1302 girls (2-18 years) from Pune city, India. Fasting hemoglobin was measured on 1118 girls and serum zinc was measured on 695 girls. Height-for-age Z-scores (HAZ) and body mass index for age Z-score (BMIZ) were computed using contemporary Indian references. HAZ >-1 was observed in 54% girls, and 18.1% were short (HAZ <-2). BMIZ was within the reference range (-2<BMIZ<2) in majority (82.4%) of the girls. Average HAZ and BMIZ were significantly higher in higher socioeconomic (HSE) than in middle (MSE) and lower (LSE) socioeconomic groups (p<0.05). Girls in all age groups had calcium, zinc, iron and vitamin intakes of <50% of Indian recommended dietary intakes. Mean nutrient intakes were significantly higher in HSE than in MSE and LSE girls (p<0.05). Girls with short stature (HAZ <-2) had significantly lower intakes of calcium, zinc, iron, β-carotene, riboflavin, niacin, folate and ascorbic acid (p<0.05). Higher levels of serum zinc and hemoglobin were observed in girls with HAZ >-1 than in short girls even after adjusting for socioeconomic status (SES). The mean serum zinc level of thin girls (BMIZ <-2) was significantly lower than those of both normal and overweight girls after adjusting for SES. Micronutrient sufficiency is of paramount importance for adequate growth in Indian girls.

Predictors of overweight and obesity in adult women in Nairobi Province, Kenya

BackgroundSince obesity in urban women is prevalent in Kenya the study aimed to determine predictors of overweight and obesity in urban Kenyan women.MethodsA cross-sectional study was undertaken in Nairobi Province. The province was purposively selected because it has the highest prevalence of overweight and obesity in Kenya.A total of 365 women aged 25–54 years old were randomly selected to participate in the study.ResultsHigher age, higher socio-economic (SE) group, increased parity, greater number of rooms in the house, and increased expenditure showed greater mean body mass index (BMI),% body fat and waist circumference (WC) at highly significant levels (p <0.001). Most of the variance in BMI was explained by age, total physical activity, percentage of fat consumed, parity and SE group in that order, together accounting for 18% of the variance in BMI. The results suggest that age was the most significant predictor of all the dependent variables appearing first in all the models, while parity was a significant predictor of BMI and WC. The upper two SE groups had significantly higher mean protein (p <0.05), cholesterol (p <0.05) and alcohol (p <0.001) intakes than the lower SE groups; while the lower SE groups had significantly higher mean fibre (p <0.001) and carbohydrate (p <0.05) intakes. A fat intake greater than 100% of the DRI dietary reference intake (DRI) had a significantly greater mean BMI (p <0.05) than a fat intake less than the DRI.ConclusionsThe predictors of overweight and obesity showed that urbanization and the nutrition transition were well established in the sample of women studied in the high SE groups. They exhibited a sedentary lifestyle and consumed a diet high in energy, protein, fat, cholesterol, and alcohol and lower in fibre and carbohydrate compared with those in the low SE groups.

Fluoridated toothpaste: usage and ingestion of fluoride by 4‐ to 6‐yr‐old children in England

Fluoridated toothpaste is effective for dental caries control, yet may be a risk factor for dental fluorosis. This study aimed to quantify fluoride ingestion from toothpaste by children and to investigate the effects of age, gender, and social class on the amount of fluoride ingested per toothbrushing session. Sixty-one children, 4-6 yr of age, were recruited: 38 were from low socio-economic (LSE) areas of Newcastle, UK, and 23 were from high socio-economic (HSE) areas of Newcastle, UK. All expectorated saliva, rinse water (if used), and residual toothpaste were collected after brushing at home and were analysed for fluoride. Of the children, 74% and 69% from HSE and LSE areas, respectively, claimed that they brushed twice per day. The mean (SD) weight of toothpaste dispensed was 0.67 (0.36) g. The mean (SD) amount of fluoride ingested per toothbrushing session and per day was 17.0 (14.7) and 29.3 (32.8) μg kg(-1) of body weight, respectively. Daily fluoride intake per kilogram of body weight did not differ significantly between children from LSE and HSE areas. Fluoride intake per toothbrushing session was significantly influenced by weight of toothpaste, its fluoride concentration, and the child's age. Whilst the average amount of toothpaste used per toothbrushing session was more than twice the recommended amount (of 0.25 g), only one child had a daily fluoride intake that exceeded the tolerable upper intake level of 0.1 mg kg(-1) of body weight for this age group.

Promoting physical activity in a low socioeconomic area: Results from an intervention targeting stair climbing

ObjectiveTo compare rates of stair climbing in a high and low socioeconomic (SE) area, and to assess the efficacy of a stair climbing intervention in each area. MethodsFrom March to May 2009 ascending stair/escalator choices (N=20,315) were observed in two underground train stations located in a high, and low, SE area of Glasgow. Baseline observations preceded a 4-week intervention in which posters, promoting stair choice, were installed. Follow-up observations were collected 1week after poster removal. ResultsBaseline stair climbing rates were 12.2% and 7.1% at the high and low SE stations, respectively. Overall, pedestrians at the high SE station were around twice as likely to climb the stairs as those at the low SE station (odds ratio [OR]=1.91, 95% confidence interval [CI]=1.70–2.15). Across sites, the rate of stair climbing was higher during the intervention relative to baseline (OR=1.48, CI=1.34–1.63) and remained elevated at follow-up (OR=1.24, CI=1.11–1.39). Absolute increase in stair climbing was similar at both stations (high SE, +4.7%; low SE, +4.5%), indicating equivalent poster effects in each area. ConclusionPedestrians in lower SE areas appear less likely to climb stairs than pedestrians in high SE areas. Nevertheless, a stair climbing intervention was equally effective in both areas.

Promoting physical activity in a low socio-economic area: results from an intervention targeting stair climbing

Background. Self-report data suggest that individuals from low socio-economic (SE) groups take less physical activity than those from high SE groups. There is no objective data to support this claim. Purpose. This study aimed to compare baseline rates of objectively measured stair climbing in a high and low SE area, and to assess the efficacy of a stair climbing intervention in each respective area. Methods. From March to May 2009, ascending stair/escalator choices (n = 20 315) were observed in two underground train stations, which were respectively located in a high, and low, SE area of Glasgow. At both sites, baseline observations were followed by a 4-week intervention in which posters, promoting stair choice, were installed. Follow-up observations were collected 1 week after poster removal. Ethical approval was obtained from Glasgow Caledonian University, School of Health Research and ethics committee. Results. Overall, pedestrians at the high SE station were around twice as likely to climb the stairs as those at the low SE station (odds ratio [OR] = 1.912, 95% confidence interval [CI] = 1.704–2.145). Across sites, the rate of stair climbing was significantly higher during the intervention relative to baseline (OR = 1.477, CI = 1.341–1.628), and remained elevated at follow-up (OR = 1.241, CI = 1.110–1.388). The increase in stair climbing was similar at both stations (high SE station, +4.7%; low SE station, +4.5%), indicating that posters had equivalent effects in each area. Conclusion. Pedestrians in lower SE areas were, overall, less likely to climb stairs than pedestrians in high SE areas. Nevertheless, a stair climbing intervention was equally effective in both areas. Copyright © 2010 John Wiley & Sons, Ltd.

Socioeconomic Position and Heart Rate Recovery After Maximal Exercise in Children

To determine whether socioeconomic (SE) position is associated with first-minute (1-minute) heart rate (HR) recovery in healthy children and adolescents (hereafter referred to as children). In a cross-sectional study, we compared 1-minute HR recovery in 3 groups of children (low, medium, and high SE) using multivariable analysis. The groups were based on neighborhood SE data extracted from the US 2000 census database. Children's Hospital Boston. Four hundred eighty children referred for exercise testing to exclude cardiac disease and discharged as showing normal results. Socioeconomic position and body mass index (BMI). Heart rate recovery after a maximal treadmill exercise test (Bruce protocol) following a consistent 1-minute cool-down period. The low SE group had a higher proportion of children with a high BMI (> or =85th percentile) (P = .07) and exercised for a shorter duration, controlling for age, sex, and BMI (P < .001). After adjusting for age (P < .001) and sex (P < .001), a significant interaction of SE group with BMI was found (P = .04). There was no difference in HR recovery in the 3 SE groups in children with a normal BMI (<85th percentile). Among children with a high BMI, only those from low and middle SE neighborhoods had impaired 1-minute HR recovery. Children with a high BMI in low and middle SE positions appear to have worse cardiovascular health compared with children with a high BMI in a high SE position.

Determinantes do valor da proteína C-reativa em indivíduos de nível sócio-econômico muito baixo

FUNDAMENTO: Inflamação sistêmica exacerbada tem sido descrita em indivíduos de baixo nível sócio-econômico, porém estudos sobre determinantes dos valores de proteína C-reativa foram realizados apenas em países desenvolvidos. OBJETIVO: Identificar preditores de PCR em indivíduos de baixo nível SE em um país em desenvolvimento e avaliar se a PCR está relacionada ao nível SE nesse cenário. MÉTODOS: Oitenta e oito indivíduos de nível SE muito baixo foram recrutados de uma comunidade pobre, semi-rural no Brasil; 32 indivíduos de nível SE alto foram utilizados como amostra de comparação. A PCR de alta sensibilidade foi medida por nefelometria. RESULTADOS: Entre os indivíduos de baixo nível SE, os preditores independentes de PCR foram índice de massa corporal > 25 kg/m² (P<0,001), hábito de fumar (P=0,005) e condições infecciosas agudas (P=0,049). O grupo com baixo nível SE (mediana=2,02 mg/l; variação interquartil: 0,92 - 4,95 mg/dl) apresentou níveis mais altos de PCR quando comparado com o grupo de alto nível SE (1,16 mg/l, variação interquartil: 0,55 - 2,50 mg/dl, P=0,03). O índice de massa corporal foi mais alto (27 ± 4,9 kg/m² vs 25,5 ± 3,2 kg/m²; P=0,07) e a prevalência de infecção aguda foi maior (32% vs 3%, P=0,002) no grupo com baixo nível SE. Após exclusão de indivíduos com sobrepeso ou condições infecciosas, os valores de PCR foram similares entre os grupos com baixo e alto nível SE (0,93 mg/l vs 1,08 mg/l, P=0,28). CONCLUSÃO: Adiposidade, condições infecciosas e fumo são preditores de PCR em indivíduos com nível SE muito baixo. Os primeiros dois fatores são os determinantes da exacerbação da inflamação em indivíduos de muito baixo nível SE.