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      Niveles de ingreso y prevalencia de tabaquismo en América Latina: revisión sistemática y metaanálisis Translated title: Income and smoking prevalence in Latin America: a systematic review and meta-analysis

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          Abstract

          RESUMEN Objetivo Determinar la relación entre la prevalencia de consumo actual de tabaco y los niveles de ingresos monetarios de fumadores en América Latina y el Caribe (ALC). Métodos Se realizó una búsqueda sistemática en bases de datos incluyendo MEDLINE, EMBASE, CENTRAL, SOCINDEX y LILACS. Se incluyeron estudios de ALC publicados desde enero 1989 hasta diciembre de 2015. Se realizaron análisis de subgrupos planeados por década calendario de los datos, país, riesgo de sesgo, sexo y grupos de edad. Resultados De un total de 1 254 estudios evaluados por texto completo se incluyeron 29 artículos, de los cuales 25 fueron incorporados en metaanálisis. Todos los estudios incluidos fueron de corte transversal o de vigilancia, la mayoría provenientes de Brasil y de México. Un bajo nivel de ingresos se asoció con una mayor prevalencia de tabaquismo activo (odds ratio [OR] 1,62; intervalo de confianza de 95% [IC95%] 1,34–1,96) con respecto al nivel alto (referencia). Se observó una tendencia de efecto dosis-respuesta: nivel medio de ingresos (OR 1,23; IC95% 1,00-1,52) y nivel bajo de ingresos (OR 1,64; IC95% 1,17-2,30). Esta asociación fue mayor en hombres (OR 2,22; IC95% 1,77-2,78) que en mujeres (OR 1,6; IC95% 1,11-2,47). Conclusiones Se observó una relación inversa entre el nivel de ingresos y la prevalencia de consumo de tabaco. Se requieren mayores esfuerzos para determinar esta relación en poblaciones especiales como adolescentes o embarazadas. Esta investigación puede ser útil para los decisores políticos al mejorar las estrategias de control del tabaco y para caracterizar cuestiones de equidad en la salud pública.

          Translated abstract

          ABSTRACT Objective Determine the relationship between tobacco-use prevalence and smoker income level in Latin America and the Caribbean (LAC). Methods A systematic search was carried out in MEDLINE, EMBASE, CENTRAL, SOCINDEX, and LILACS databases. Studies from LAC published from January 1989 to December 2015 were included and were analyzed by subgroups disaggregated by decade of data, country, bias risk, sex, and age group. Results Of 1 254 studies evaluated by full text, 29 articles were included, of which 25 were chosen for meta-analysis. All included studies were cross-sectional or surveillance, primarily from Brazil and Mexico. Low income was associated with higher prevalence of active smoking (odds ratio [OR] 1.62; 95% confidence interval [95%CI] 1.34–1.96) than high income (reference). A dose-response effect trend was observed: middle income (OR 1.23; 95%CI 1.00-1.52) and low income (OR 1.64; 95%CI 1.17-2.30). This association was greater in men (OR 2.22; 95%CI 1.77-2.78) than in women (OR 1.6; 95%CI 1.11-2.47). Conclusions An inverse relationship was observed between income and tobacco-use prevalence. Further efforts are required to determine this relationship in special populations, such as adolescents and pregnant women. This research can be useful for policymakers by improving tobacco control strategies and for characterizing public health equity issues.

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          Measuring living standards with proxy variables.

          Very few demographic surveys in developing countries have gathered information on household incomes or consumption expenditures. Researchers interested in living standards therefore have had little alternative but to rely on simple proxy indicators. The properties of these proxies have not been analyzed systematically. We ask what hypotheses can be tested using proxies, and compare these indicators with consumption expenditures per adult, our preferred measure of living standards. We find that the proxies employed in much demographic research are very weak predictors of consumption per adult. Nevertheless, hypothesis tests based on proxies are likely to be powerful enough to warrant consideration.
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            Social Determinants of Health and Tobacco Use in Thirteen Low and Middle Income Countries: Evidence from Global Adult Tobacco Survey

            Background Tobacco use has been identified as the single biggest cause of inequality in morbidity. The objective of this study is to examine the role of social determinants on current tobacco use in thirteen low-and-middle income countries. Methodology/Principal Findings We used nationally representative data from the Global Adult Tobacco Survey (GATS) conducted during 2008–2010 in 13 low-and-middle income countries: Bangladesh, China, Egypt, India, Mexico, Philippines, Poland, Russian Federation, Thailand, Turkey, Ukraine, Uruguay, and Viet Nam. These surveys provided information on 209,027 respondent's aged 15 years and above and the country datasets were analyzed individually for estimating current tobacco use across various socio-demographic factors (gender, age, place of residence, education, wealth index, and knowledge on harmful effects of smoking). Multiple logistic regression analysis was used to predict the impact of these determinants on current tobacco use status. Current tobacco use was defined as current smoking or use of smokeless tobacco, either daily or occasionally. Former smokers were excluded from the analysis. Adjusted odds ratios for current tobacco use after controlling other cofactors, was significantly higher for males across all countries and for urban areas in eight of the 13 countries. For educational level, the trend was significant in Bangladesh, Egypt, India, Philippines and Thailand demonstrating decreasing prevalence of tobacco use with increasing levels of education. For wealth index, the trend of decreasing prevalence of tobacco use with increasing wealth was significant for Bangladesh, India, Philippines, Thailand, Turkey, Ukraine, Uruguay and Viet Nam. The trend of decreasing prevalence with increasing levels of knowledge on harmful effects of smoking was significant in China, India, Philippines, Poland, Russian Federation, Thailand, Ukraine and Viet Nam. Conclusions/Significance These findings demonstrate a significant but varied role of social determinants on current tobacco use within and across countries.
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              Critical appraisal of published research: introductory guidelines.

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rpsp
                Revista Panamericana de Salud Pública
                Rev Panam Salud Publica
                Organización Panamericana de la Salud (Washington, Washington, United States )
                1020-4989
                1680-5348
                October 2016
                : 40
                : 4
                : 263-271
                Affiliations
                [0001] orgnameInstituto de Efectividad Clínica y Sanitaria (IECS-CONICET) orgdiv1Centro Cochrane Argentino
                [0002] Cali Valle del Cauca orgnameUniversidad del Valle orgdiv1Hospital Universitario del Valle Colombia
                Article
                S1020-49892016001000263
                28001203
                9e391249-c091-419b-9f33-7150e4266a25

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

                History
                : 30 March 2016
                : 24 February 2016
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 35, Pages: 9
                Product

                SciELO Public Health


                Uso de tabaco,equidad,economía de la salud,Tobacco use,equity,health economics

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