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      Socioeconomic Inequalities in Gastroesophageal Reflux Disorder: Results from an Iranian Cohort Study

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          Abstract

          BACKGROUND

          Despite progress in the health indexes in recent years, health inequalities remain as a global challenge within and between regions and countries. This study is the first to quantify the socioeconomic inequity in gastroesophageal reflux disease (GERD) using the concentration index.

          METHODS

          In this cross-sectional study, we used baseline data (7012 subjects) from the Fasa Cohort Study (the Southern Iran). The principal component analysis was used to construct socioeconomic status of the participants. The concentration index and concentration curve were used to measure socioeconomic-related inequality in GERD. Decomposition of concentration index was also done to identify the contribution of each explanatory variable to the wealth-related inequality in GERD prevalence.

          RESULTS

          The prevalence of GERD was 16.9% (95% CI: 15.9-17.7%). The overall concentration index for GERD was 0.093 (95% CI: 0.062-0.166]. Correspondingly, this figure for men and women were 0.116 (95% CI: 0.062-0.171%) and 0.091 (95% CI: 0.044-0.137%), respectively. The main contributors of socioeconomic-related inequality in GERD prevalence were socioeconomic status (64.4%), alcohol drinking (29%), and age (8.4%).

          CONCLUSION

          GERD is significantly more concentrated among richest people. There was significant socioeconomic inequality in GERD according to some individual factors. These inequalities need to be addressed by policy makers to identify the vulnerable subgroups and to reduce the disease burden in the community.

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          Prospective Epidemiological Research Studies in Iran (the PERSIAN Cohort Study): Rationale, Objectives, and Design.

          Hossein Poustchi, Sareh Eghtesad, Farin Kamangar … (2018)
          Noncommunicable diseases (NCDs) account for 76% of deaths in Iran, and this number is on the rise, in parallel with global rates. Many risk factors associated with NCDs are preventable; however, it is first necessary to conduct observational studies to identify relevant risk factors and the most appropriate approach to controlling them. Iran is a multiethnic country; therefore, in 2014 the Ministry of Health and Medical Education launched a nationwide cohort study-Prospective Epidemiological Research Studies in Iran (PERSIAN)-in order to identify the most prevalent NCDs among Iran's ethnic groups and to investigate effective methods of prevention. The PERSIAN study consists of 4 population-based cohorts; the adult component (the PERSIAN Cohort Study), described in this article, is a prospective cohort study including 180,000 persons aged 35-70 years from 18 distinct areas of Iran. Upon joining the cohort, participants respond to interviewer-administered questionnaires. Blood, urine, hair, and nail samples are collected and stored. To ensure consistency, centrally purchased equipment is sent to all sites, and the same team trains all personnel. Routine visits and quality assurance/control measures are taken to ensure protocol adherence. Participants are followed for 15 years postenrollment. The PERSIAN study is currently in the enrollment phase; cohort profiles will soon emerge.
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            The PERSIAN Cohort: Providing the Evidence Needed for Healthcare Reform.

            Sareh Eghtesad, Zahra Mohammadi, Amaneh Shayanrad … (2017)
            In the past, communicable diseases caused the highest mortality in Iran. Improvements in socioeconomic status and living standards including access to safe drinking water, along with the inception of Health Houses in the 1980s, have changed disease patterns, decreasing the spread of and deaths from infectious and communicable diseases. The incidence and prevalence of non-communicable diseases (NCD), however, have now increased in Iran, accounting for nearly 80% of deaths and disabilities. Without interventions, NCD are predicted to impose a substantial human and economic burden in the next 2 decades. However, Iran's health system is not equipped with the necessary policies to combat this growth and must refocus and reform. Therefore, in the year 2013, the Ministry of Health and Medical Education funded a well-designed nationwide cohort study-Prospective Epidemiological Research Studies in IrAN (PERSIAN)-in order to assess the burden of NCD and investigate the risk factors associated with them in the different ethnicities and geographical areas of Iran. The PERSIAN Cohort, which aims to include 200000 participants, has 4 components: Adult (main), Birth, Youth and Elderly, which are being carried out in 22 different regions of Iran. Having an enormous dataset along with a biobank of blood, urine, hair and nail samples, the PERSIAN Cohort will serve as an important infrastructure for future implementation research and will provide the evidence needed for new healthcare policies in order to better control, manage and prevent NCD.
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              Systematic review on epidemiology of gastroesophageal reflux disease in Asia.

              Yoshikazu Kinoshita, Benjamin C Y Wong (2006)
              The epidemiology of gastroesophageal reflux disease (GERD) has been a subject of much interest in recent years. This review ascertains the prevalence of GERD in eastern and southeastern Asia, and reports on complications and risk factors. This qualitative systematic review of the epidemiology of GERD in eastern and southeastern Asia identified studies in adults reported in English in the Medline database (searched through April 2005), relevant reviews, and our own bibliographic databases. Thirteen studies were included. The reported population prevalence of GERD in eastern Asia ranged from 2.5% to 6.7% for at least weekly symptoms of heartburn and/or acid regurgitation and may be increasing. No reliable data are available on the prevalence of esophagitis in the general population. In case studies, the prevalence of reflux esophagitis ranged from 3.4% to 16.3%. Well-established risk factors for GERD in Asian populations included hiatus hernia and obesity. Age and male sex also may be risk factors. Chest pain is the predominant extraesophageal manifestation of GERD in China, whereas in Japan, a link with asthma has been implicated in patients with severe esophagitis. There is a paucity of studies reporting the prevalence of GERD in eastern and southeastern Asia. These results highlight the need for further epidemiologic studies using representative study populations and a standardized methodology. Recognition and awareness of GERD need to increase concomitantly to ensure appropriate diagnosis and treatment of the disease.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Middle East J Dig Dis
                Journal ID (publisher-id): Middle East J Dig Dis
                Journal ID (publisher-id): MEJDD
                Title: Middle East Journal of Digestive Diseases
                Publisher: Iranian Association of Gastroerterology and Hepatology
                ISSN (Print): 2008-5230
                ISSN (Electronic): 2008-5249
                Publication date (Print): July 2018
                Publication date (Electronic): 10 June 2018
                Volume: 10
                Issue: 3
                Pages: 180-187
                Affiliations
                1 Non-Communicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
                2 Center for Diseases Control and Prevention, Deputy of Health Services, Fasa University of Medical Sciences, Fasa, Iran
                3 Research Centre for Health Sciences, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
                4 Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
                Author notes
                [* ] Corresponding Author: Shahab Rezaeian, PhD Department of Epidemiology, School of Health, Kermanshah University of Medical Sciences, Isar Sq, Kermanshah 6719851351, Iran Telefax: + 98 83 38262005 Email: shahab.rezayan@ 123456gmail.com
                Article
                DOI: 10.15171/mejdd.2018.108
                PMC ID: 6119839
                PubMed ID: 30186582
                SO-VID: da55f8a4-f812-40b8-82bd-3b4d40dfe08c
                Copyright © © 2018 The Author(s)
                License:

                This work is published by Middle East Journal of Digestive Diseaes as an open access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by-nc/4.0/). Non-commercial uses of the work are permitted, provided the original work is properly cited.

                History
                Date received : 09 February 2018
                Date accepted : 07 June 2018
                Page count
                Figures: 1, Tables: 3, References: 48, Pages: 8
                Categories
                Subject: Original Article

                Keywords: gastroesophageal reflux,concentration index,inequality,persian cohort,iran
                Data availability:
                Keywords: gastroesophageal reflux, concentration index, inequality, persian cohort, iran

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