Impact of education, income and chronic disease risk factors on mortality of adults: does 'a pauper-rich paradox' exist in Latin American societies?

OBJECTIVES: To test the hypothesis that an inverse association exists between socio-economic position and all-cause mortality in a developing country in Latin America. STUDY DESIGN: Prospective cohort study carried out in Chile using data from a simple random sample of 920 apparently healthy subjects (weighted population 11,600 aged 30-89 years) followed for 8 years. METHODS: Education level (0-8 years, 9-12 years and > or = 13 years) and income quartiles were established at the outset of the study, along with behavioural and biological risk factors for chronic diseases: smoking, alcohol use, obesity, diabetes, hypertension, lipids and family history of death by cardiovascular disease. Relative risks of all-cause mortality were estimated using age-adjusted Cox regression models. RESULTS: During the follow-up period, 46 deaths were observed. Adjusting for age, gender, and behavioural and biological risk factors, the mortality risk for increasing categories of education after controlling for income was 1.0, 0.76 and 0.33 (P for trend<0.01). In contrast, the relative risk for increasing levels of income after controlling for education was 1.0, 0.98, 1.33 and 1.17 (P for trend=0.07). CONCLUSION: While education level had a protective effect on mortality risk of Chilean adults, income had a slightly unfavourable effect on survival. This finding is described as suggestive of a 'pauper-rich paradox', since the higher income quantiles in this study correspond with the lower income levels in most developed countries. Nevertheless, due to the small number of deaths, additional research is required to assess the validity of these findings.

[Infectious endocarditis: prognostic factors of mortality in 131 cases]. / Endocarditis infecciosa: factores pronósticos de mortalidad en 131 casos.

BACKGROUND: Global hospital mortality for infective endocarditis ranges from 13 to 40%. AIM: To compare clinical, microbiological, echocardiographic factors and complications between patients that died during an episode of infective endocarditis and those who survived. PATIENTS AND METHODS: We followed during their hospital stay, 129 patients, aged 14 to 74 years old, who had 131 episodes of infective endocarditis. Clinical assessment, echocardiography and microbiological study was done to all patients. Surgical indications were those derived from complications. RESULTS: Thirty three patients died during hospital stay (25.2%). There were no differences between survivors and deceased patients in the lapse between onset of symptoms and hospital admission, presence of fever, dyspnea or heart murmurs. Skin and mucosal septic manifestations occurred with higher frequency in deceased patients (57.1 and 24.3% respectively). Blood cultures were positive in 55% in survivors and 48% in those who died. The most frequent infecting organisms were staphilococci and streptococci. Vegetations were found with greater frequency in aortic position in both groups of patients. Deceased patients had a higher frequency of cardiac failure (84 and 65% respectively) and embolic episodes (77 and 46% respectively) than survivors. Antimicrobial treatment was successful in 94% of survivors and 15% of those who died. Forty percent of survivors and 54% of deceased patients were subjected to surgical procedures. CONCLUSIONS: The most important predictor of hospital mortality in this series of patients with infective endocarditis was antimicrobial treatment failure.

[Infective endocarditis: clinical aspects and necropsy study in 20 cases]. / Endocarditis infecciosa: aspectos clínicos y estudio necropsico en 20 casos.

Aiming to know the principal anatomo-pathological findings in patients that died with a diagnosis of infective endocarditis, the clinical histories and necropsy protocols of such patients that died between 1984 and 1989 were reviewed. Twenty patients (11 male) aged 43.2 +/- 16.1 years were studied. In nine, the endocarditis was subacute, and 80% had a history of valvular or congenital heart disease. The principal clinical complication was sepsis followed by neurological, nephrological and cardiac complications. The necropsy disclosed cardiac, nephrological and abdominal lesions in 100, 80 and 65% of patients respectively. In 65% of necropsies, neurological injuries were found (cerebral edema in 7 patients and hemorrhagic complications in 11). It is concluded that extra cardiac lesions are frequent in patients dying with a diagnosis of infective endocarditis.

[Infectious endocarditis: clinical and echocardiographic initial follow-up]. / Endocarditis infecciosa: seguimiento inicial clínico-ecocardiográfico.

We analyzed the clinical and echocardiographic features of 24 patients with infective endocarditis followed for a mean of 20.2 month (range 3-84) after discharge. Mean age was 38 years, male to female ratio was 2:1 and 87% of cases had a subacute clinical course; 17% of patients had late prosthetic endocarditis. Positive blood cultures were obtained in only 50% of patients. Vegetations were detected by echocardiography in 88%, 66% of them located at the aortic valve. Heart failure (62%) was the main complication, leading to valve replacement in 4 patients. Four patients died during follow up, 3 males due to heart failure and a female from systemic emboli. Twenty patients survive at the end of follow up (84%), 50% of them in FC I or II, 40% in FC III or IV (2 lost to follow up). Eleven patients had a late echocardiogram at a mean of 12 months after discharge: 6 of them showed persistence of vegetations (55%).