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Determinantes sociais na prevalência de catarata na população europeia com idade igual ou superior a 50 anos: um estudo transversal
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RESUMO - Introdução: Atualmente, as cataratas são, ao nível mundial, a principal causa de
cegueira, a segunda causa de baixa visão e a segunda maior responsável da carga da
doença oftalmológica. Neste contexto, torna-se importante compreender e identificar os
determinantes da prevalência da catarata, de forma a desenhar políticas efetivas para
reduzir a carga epidemiológica e económica desta patologia. Neste sentido, o presente
estudo teve como objetivo medir a associação entre o estatuto socioeconómico e a
prevalência de catarata, em países europeus, e se esta relação é mediada pelos
comportamentos de risco e fatores associados à doença.
Metodologia: Foram utilizados os dados da sexta vaga do Survey of Health, Ageing
and Retirement in Europe de 2015. O estudo englobou 65.056 indivíduos de 17 países
europeus, com 50 ou mais anos. Foi aplicado um modelo de regressão logística para
medir a associação entre as variáveis socioeconómicas (educação e pobreza subjetiva)
e a prevalência de catarata. Posteriormente, realizou-se uma análise de mediação,
através da aplicação de dois modelos de regressão logística para apurar se esta
associação é explicada por comportamentos de risco (hábitos tabágicos, hábitos de
consumo regular de álcool e sedentarismo) e fatores associados à catarata (diabetes,
hipertensão arterial e obesidade).
Resultados: Os resultados mostram que a probabilidade de desenvolver cataratas é
28,5% superior em indivíduos com educação primária (OR=1,285; p<0,001), em
comparação com os indivíduos de educação terciária. Também é 40% superior em
indivíduos que referem que o seu rendimento mensal chega ao final do mês “com muita
dificuldade” (OR=1,396; p<0,001), em relação aos que referem chegar “com facilidade”.
Na análise de mediação, e ao incluir as variáveis de estilos de vida, os OR das
categorias “sem educação” e “com muita dificuldade” diminuíram. Ao incluir os fatores
associados, o OR da categoria “com muita dificuldade” voltou a diminuir, e as categorias
“sem educação” e “com alguma dificuldade” deixaram de ser estatisticamente
significativas. Estes resultados demonstram que a associação entre estatutos
socioeconómicos inferiores com o risco de ter catarata é explicada, em parte, pela maior
prevalência dos comportamentos de risco (hábitos tabágicos e alcoólicos, e
sedentarismo) e dos fatores associados (obesidade, hipertensão arterial e diabetes) nos
grupos mais desfavorecidos.
Conclusão: Estes resultados confirmam que a prevalência da catarata não se distribui
de forma igual na população com 50 ou mais anos, sendo maior nas pessoas mais
desfavorecidas. O papel dos fatores de risco na explicação desta relação indica a
necessidade de implementar políticas que fomentem estilos de vida saudáveis
particularmente focadas nas populações mais vulneráveis, no sentido de limitar as
desigualdades sociais na prevalência de catarata.
ABSTRACT -Introduction: Currently, cataracts are the leading cause of blindness, the second cause of low vision, and the second largest cause of ophthalmic disease burden worldwide. In this context, it is important to understand and identify the determinants of cataract prevalence, in order to design effective policies to reduce the epidemiological and economic burden of this pathology. This study aimed to measure the association between socioeconomic status and the prevalence of cataract in European countries, and whether this relationship is mediated by risk behaviors and factors associated with the disease. Methodology: Data from the sixth wave of the Survey of Health, Ageing and Retirement in Europe of 2015 were used. The study included 65.056 individuals from 17 European countries, aged 50 years or older. A logistic regression model was used to measure the association between socioeconomic variables (education and subjective poverty) and the prevalence of cataract. Subsequently, a mediation analysis was performed through the application of two logistic regression models to determine if this association was explained by risk behaviors (smoking habits, alcoholic habits and sedentary lifestyle) and factors associated with cataract (diabetes, arterial hypertension and obesity). Results: The results show that the probability of developing cataracts is 28,5% higher in individuals with primary education (OR = 1,285; p<0,001) compared to individuals in tertiary education. It is also 40% higher in individuals who report that their household’s total monthly income is able to make end meet "with great difficulty" (OR = 1,396; p<0,001), in relation to those who report "easily". In the analysis of mediation, and by including the variables of lifestyle, the OR of the "no education" and "very difficult" categories decreased. By including the associated factors, the OR of the category "with great difficulty" decreased again, and the categories "no education" and "with some difficulty" were no longer statistically significant. These results demonstrate that the association between lower socioeconomic status and the risk of having cataracts is partly explained by the higher prevalence of risk behaviors (smoking and alcoholism, and sedentary lifestyle) and associated factors (obesity, hypertension and diabetes) in the disadvantaged groups. Conclusion: These results confirm that the prevalence of cataracts is not evenly distributed in the population aged 50 years or older, being higher in the most disadvantaged people. The role of risk factors in explaining this relationship indicates the need to implement policies that promote healthy lifestyles that are particularly focused on the most vulnerable populations, in order to limit social inequalities in the prevalence of cataracts.
ABSTRACT -Introduction: Currently, cataracts are the leading cause of blindness, the second cause of low vision, and the second largest cause of ophthalmic disease burden worldwide. In this context, it is important to understand and identify the determinants of cataract prevalence, in order to design effective policies to reduce the epidemiological and economic burden of this pathology. This study aimed to measure the association between socioeconomic status and the prevalence of cataract in European countries, and whether this relationship is mediated by risk behaviors and factors associated with the disease. Methodology: Data from the sixth wave of the Survey of Health, Ageing and Retirement in Europe of 2015 were used. The study included 65.056 individuals from 17 European countries, aged 50 years or older. A logistic regression model was used to measure the association between socioeconomic variables (education and subjective poverty) and the prevalence of cataract. Subsequently, a mediation analysis was performed through the application of two logistic regression models to determine if this association was explained by risk behaviors (smoking habits, alcoholic habits and sedentary lifestyle) and factors associated with cataract (diabetes, arterial hypertension and obesity). Results: The results show that the probability of developing cataracts is 28,5% higher in individuals with primary education (OR = 1,285; p<0,001) compared to individuals in tertiary education. It is also 40% higher in individuals who report that their household’s total monthly income is able to make end meet "with great difficulty" (OR = 1,396; p<0,001), in relation to those who report "easily". In the analysis of mediation, and by including the variables of lifestyle, the OR of the "no education" and "very difficult" categories decreased. By including the associated factors, the OR of the category "with great difficulty" decreased again, and the categories "no education" and "with some difficulty" were no longer statistically significant. These results demonstrate that the association between lower socioeconomic status and the risk of having cataracts is partly explained by the higher prevalence of risk behaviors (smoking and alcoholism, and sedentary lifestyle) and associated factors (obesity, hypertension and diabetes) in the disadvantaged groups. Conclusion: These results confirm that the prevalence of cataracts is not evenly distributed in the population aged 50 years or older, being higher in the most disadvantaged people. The role of risk factors in explaining this relationship indicates the need to implement policies that promote healthy lifestyles that are particularly focused on the most vulnerable populations, in order to limit social inequalities in the prevalence of cataracts.
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Catarata Estatuto socioeconómico Educação Pobreza subjetiva Desigualdades SHARE Cataract Socioeconomic status Education Subjective poverty Inequalities