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Epidemiology of cardiovascular disease in rural Vietnam
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In the context of transitional Vietnam, although cardiovascular disease (CVD) has been shown to cause a large burden of mortality and morbidity in hospitals, little is known about the magnitude of its burden, risk factor levels and its relationship with socio-demographic status in the overall population. This thesis provides a preliminary insight into population-based knowledge of the CVD epidemiology in rural Vietnam and contributes to the development of methodologies for monitoring it. The ultimate goal of the work is to facilitate the formulation of evidence-based health interventions for reducing the burden of the CVD epidemic in Vietnam and elsewhere.

This work was located in Bavi district, a rural community in the north of Vietnam. Studies on cause-specific mortality and risk factors were conducted within the framework of an ongoing Demographic Surveillance System (DSS) (called FilaBavi). The cause-specific mortality study used a verbal autopsy (VA) approach to identify causes of death in FilaBavi during 1999-2003. The risk factor study, conducted in 2002, employed the WHO STEPwise approach to surveillance of non-communicable disease (NCD) risk factors (WHO STEPS).

Findings indicated that Bavi district, as an example of rural Vietnam, was already experiencing high rates of CVD mortality and associated risk factors. Mortality results indicated a substantial proportion of deaths due to CVD, which was the leading cause of death (20% and 25.7% of total mortality in 1999 and 2000, respectively and 32% of adult deaths during 1999-2003), exceeding infectious diseases. Hypertension was found to be a serious problem in terms both of its magnitude (14% of the population) and widespread unawareness (82% of the hypertensives). Smoking prevalence was very high among men (58% current daily smokers) and might be expected to cause a considerable number of future deaths without urgent action. CVD mortality and some risk factors seemed to be rising among disadvantaged groups (women, less educated people and the poor). The combination of DSS and WHO STEPS methodologies was shown to have potential for addressing basic epidemiological questions as to how NCD and CVD mortality and associated risk factors are distributed in populations.

Given this evidence, actions to prevent CVD in Bavi and similar settings are clearly urgent. Interventions should be comprehensive and integrated, including both primary and secondary approaches, as well as policy-level involvement. Further studies, continuing on similar lines, plus qualitative approaches and deeper cross-site comparisons, are also needed to give further insights into CVD epidemiology in this type of setting.

Place, publisher, year, edition, pages
Umeå: Folkhälsa och klinisk medicin , 2006. , 74 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1018
Keyword [en]
Cardiovascular disease, epidemiology, risk factors, rural Vietnam
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-779ISBN: 91-7264-049-9 (print)OAI: oai:DiVA.org:umu-779DiVA: diva2:144495
Public defence
2006-05-19, Sal 135, 9B, Allmänmedicin, Norrlands Universitetssjukhus, 901 85 Umeå, 13:00 (English)
Opponent
Supervisors
Available from: 2006-04-28 Created: 2006-04-28 Last updated: 2009-10-20Bibliographically approved
List of papers
1. Combining risk factors and demographic surveillance: potentials of WHO STEPS and INDEPTH methodologies for assessing epidemiological transition.
Open this publication in new window or tab >>Combining risk factors and demographic surveillance: potentials of WHO STEPS and INDEPTH methodologies for assessing epidemiological transition.
Show others...
2006 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 34, no 2, 199-208 p.Article in journal (Refereed) Published
Abstract [en]

AIMS: Demographic surveillance systems (DSSs) create platforms to monitor population dynamics. This paper discusses the potential of combining the WHO STEPwise approach to Surveillance (STEPS) within ongoing DSSs, to assess changes in non-communicable disease (NCD) risk factors. METHODS: Three DSSs in Ethiopia, Vietnam, and Indonesia have collected NCD risk factors using WHO STEPS, focusing on self-reported lifestyle risk factors (Step 1) and measurement of blood pressure and anthropometric parameters (Step 2). RESULTS: DSSs provide sampling frames for NCD risk factor surveillance, which reveals the distribution of risk factors and their dynamics at the population level. The WHO STEPS approach with its add-on modules is feasible and adaptable in DSS settings. Available mortality data in the DSSs enable mortality assessment by cause of death using verbal autopsy, which is relevant in estimating the impact of NCDs. DSSs as well as risk factor surveillance data may potentially be a lever for hypothesis-driven research to address specific a priori hypotheses or research questions. CONCLUSION: Combining DSSs with the WHO STEPS approach can potentially address basic epidemiological questions on NCDs, which can be used as a powerful advocacy tool in public health decision-making for NCD prevention.

Keyword
Adult, Chronic Disease/*epidemiology, Developing Countries/statistics & numerical data, Ethiopia/epidemiology, Female, Humans, Indonesia/epidemiology, Life Style, Male, Middle Aged, Population Surveillance/methods, Risk Factors, Vietnam/epidemiology, World Health
Identifiers
urn:nbn:se:umu:diva-16189 (URN)10.1080/14034940500204506 (DOI)16581713 (PubMedID)
Available from: 2008-01-11 Created: 2008-01-11 Last updated: 2017-10-12Bibliographically approved
2. Applying verbal autopsy to determine cause of death in rural Vietnam
Open this publication in new window or tab >>Applying verbal autopsy to determine cause of death in rural Vietnam
2003 (Swedish)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 31, no Suppl. 62, 19-25 p.Article in journal (Refereed) Published
Abstract [sv]

Aims: Verbal autopsy (VA) is an attractive method for ascertaining causes of death in settings where the proportion of

people who die under medical care is low. VA has been widely used to determine causes of childhood and maternal deaths,

but has had limited use in assessing causes in adults and across all age groups. The objective was to test the feasibility of

using VA to determine causes of death for all ages in Bavi District, Vietnam, in 1999, leading to an initial analysis of the

mortality pattern in this area. Methods: Trained lay field workers interviewed a close caretaker of the deceased using a

combination closed/open-ended questionnaire. Results: A total of 189 deaths were studied. Diagnoses were made by two

physicians separately, with good agreement (k~0.84) and then combined to reach one single underlying cause of death for

each case. The leading causes of death were cardiovascular and infectious diseases (accounting for 20.6% and 17.9% of the

total respectively). Drowning was very prevalent in children under 15 (seven out of nine cases of drowning were in this age

group). Discussion: One month seemed an acceptable minimum recall period to ensure mourning procedures were over. A

combination VA questionnaire was an appropriate instrument provided it was supported by adequate training of

interviewers. Two physicians were appropriate for making the diagnoses but predefined diagnostic methods for common

causes should be developed to ensure more replicable results and comparisons, as well as to observe trends of mortality over

time. The causes of death in this study area reflect a typical pattern for developing countries that are in epidemiological

transition. No maternal deaths and a low infant mortality rate may be the result of improvements in maternal and child

health in this study area. Using the VA gave more precise causes of death than those reported at death registration.

Although the validity of the VA method used has not been fully assessed, it appeared to be an appropriate method for

ascertaining causes of death in the study area.

Key words: cause of death, community data, field survey, mortality, verbal autopsy, Vietnam.

Identifiers
urn:nbn:se:umu:diva-12510 (URN)doi:10.1080/14034950310015068 (DOI)14649633 (PubMedID)
Available from: 2006-04-26 Created: 2006-04-26 Last updated: 2017-12-14Bibliographically approved
3. Cardiovascular disease mortality and its association with socioeconomic status: findings from a population-based cohort study in rural Vietnam, 1999-2003.
Open this publication in new window or tab >>Cardiovascular disease mortality and its association with socioeconomic status: findings from a population-based cohort study in rural Vietnam, 1999-2003.
Show others...
2006 (English)In: Preventing Chronic Disease, ISSN 1545-1151, E-ISSN 1545-1151, Vol. 3, no 3, A89- p.Article in journal (Refereed) Published
Keyword
Adult, Aged, Cardiovascular Diseases/*economics/*mortality, Cohort Studies, Female, Humans, Male, Middle Aged, Rural Population/*statistics & numerical data, Socioeconomic Factors, Vietnam/epidemiology
Identifiers
urn:nbn:se:umu:diva-14138 (URN)16776890 (PubMedID)
Available from: 2007-08-28 Created: 2007-08-28 Last updated: 2017-12-14Bibliographically approved
4. Gender differences in prevalence and sosioeconomic determinants of hypertension: findings from the WHO STEPs survey in a rural community of Vietnam
Open this publication in new window or tab >>Gender differences in prevalence and sosioeconomic determinants of hypertension: findings from the WHO STEPs survey in a rural community of Vietnam
2006 (English)In: Journal of Human Hypertension, ISSN 0950-9240, E-ISSN 1476-5527, Vol. 20, no 2, 109-115 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:umu:diva-5106 (URN)10.1038/sj.jhh.1001942 (DOI)16195706 (PubMedID)
Available from: 2006-04-28 Created: 2006-04-28 Last updated: 2017-12-14Bibliographically approved
5. Smoking epidemics and socio-economic predictors of regular use and cessation: Findings from WHO STEPS risk factor surveys in Vietnam and Indonesia
Open this publication in new window or tab >>Smoking epidemics and socio-economic predictors of regular use and cessation: Findings from WHO STEPS risk factor surveys in Vietnam and Indonesia
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2006 (English)In: Internet Journal of Epidemiology, ISSN 1540-2614, Vol. 3, no 1Article in journal (Refereed) Published
Abstract [en]

A population-based surveys were carried out in two demographic surveillance sites (DSSs) in Vietnam and Indonesia using the WHO STEPS approach to surveillance of non-communicable disease risk factors in order to characterize smoking epidemics in rural communities of Vietnam and Indonesia by identifying associations between socio-economic status and changes in smoking status among adult populations. The paper reveals that

the prevalence of smoking among people aged 25-54 years was higher in Indonesia than in Vietnam. Indonesian men started smoking regularly earlier and ceased less than Vietnamese men. While low income was found to be a significant predictor of becoming regular smokers in Vietnam, old birth cohort and low education significantly increased the probability of being a regular smoker in Indonesia. Economic status was also found to be a significant predictor of smoking cessation in Vietnam while education and occupation played an important role in Indonesia

Keyword
Smoking epidemic, socio-economic determinants, Vietnam, Indonesia, WHO STEPS
Identifiers
urn:nbn:se:umu:diva-12541 (URN)
Note
paper is accepted for publicationAvailable from: 2007-12-17 Created: 2007-12-17 Last updated: 2015-04-29Bibliographically approved

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