What are we missing? The profile of non-respondents in the Finnish Gambling 2015 survey.

Aims: Population-based gambling surveys provide important information about gambling frequency, problems, attitude and opinions of the general population. This information can be used by social and health care professionals, service providers and policy makers. However, low response rates may cause biased findings. The aim was to define the profile of non-respondents in the Finnish Gambling 2015 survey. Methods: The survey sample (N = 7400) was obtained from the national Population Information System and the survey was conducted using computer-assisted telephone interviews (response rate 62%). The study sample including individuals aged 18-74 was linked to administrative registers to obtain socio-demographic information (sex, age, marital status, education, socio-economic status, net income, residential area) about the respondents and the non-respondents. Register-based information was used to build a non-respondent profile for the survey. Results: The non-response was more prevalent among women, 18- to 24-year-olds, non-married, individuals with primary education, unemployed (vs. self-employed and students) and residents in urban areas. When net income was added to the model, the associations of women and unemployed (vs. self-employed) with non-response became non-significant, while the non-response was more prevalent among the lowest quintile of net income. Conclusions: Socio-economic position was associated with lower response rate which may cause bias while studying gambling behaviour of socio-economically vulnerable individuals. Obtaining additional auxiliary information through record linkage to administrative registers and use of more sophisticated methods for controlling bias caused by non-response, such as multiple imputation, would offer information about the impact of non-response to the results related to gambling and gambling problems.

Trends in obesity and energy supply in the WHO MONICA Project.

OBJECTIVE: To examine the relationship between secular trends in energy supply and body mass index (BMI) among several countries. DESIGN: Aggregate level analyses of annually reported country food data against anthropometric data collected in independent cross-sectional samples from 34 populations in 21 countries from the early 1980s to the mid-1990s. SUBJECTS: Population randomly selected participants aged 35-64 y. MEASUREMENTS: BMI data were obtained from the WHO MONICA Project. Food energy supply data were derived from the Food Balance Sheet of the Food and Agriculture Organization of the United Nations. RESULTS: Mean BMI as well as the prevalence of overweight (BMI > or =25 kg/m2) increased in virtually all Western European countries, Australia, the USA, and China. Decreasing trends in BMI were seen in Central and Eastern European countries. Increasing trends in total energy supply per capita were found in most high-income countries and China while decreasing trends existed in Eastern European countries. Between country differences in temporal trends of total energy supply per capita explained 41% of the variation of trends in mean BMI; the effect was similar upon the prevalence of overweight and obesity. Trends in percent of energy supply from total fat per capita had a slight effect on the trends in mean BMI (+7% increment in R2) when the total energy supply per capita was adjusted for, while energy supply from total sweeteners per capita had no additional effect. CONCLUSION: Increasing energy supply is closely associated with the increase of overweight and obesity in western countries. This emphasizes the importance of dietary issues when coping with the obesity epidemic.

Trends in coronary risk factors in the WHO MONICA project.

BACKGROUND: The World Health Organization (WHO) MONICA Project was established to determine how trends in event rates for coronary heart disease (CHD) and, optionally, stroke were related to trends in classic coronary risk factors. Risk factors were therefore monitored over ten years across 38 populations from 21 countries in four continents (overall period covered: 1979-1996). METHODS: A standard protocol was applied across participating centres, in at least two, and usually three, independent surveys conducted on random samples of the study populations, well separated within the 10-year study period. RESULTS: Smoking rates decreased in most male populations (35-64 years) but in females the majority showed increases. Systolic blood pressure showed decreasing trends in the majority of centres in both sexes. Mean levels of cholesterol generally showed downward trends, which, although the changes were small, had large effects on risk. There was a trend of increasing body mass index (BMI) with half the female populations and two-thirds of the male populations showing a significant increase. CONCLUSIONS: It is feasible to monitor the classic CHD risk factors in diverse populations through repeated surveys over a decade. In general, the risk factor trends are downwards in most populations but in particular, an increase in smoking in women in many populations and increasing BMI, especially in men, are worrying findings with significant public health implications.

Estimation of contribution of changes in classic risk factors to trends in coronary-event rates across the WHO MONICA Project populations.

BACKGROUND: From the mid-1980s to mid-1990s, the WHO MONICA Project monitored coronary events and classic risk factors for coronary heart disease (CHD) in 38 populations from 21 countries. We assessed the extent to which changes in these risk factors explain the variation in the trends in coronary-event rates across the populations. METHODS: In men and women aged 35-64 years, non-fatal myocardial infarction and coronary deaths were registered continuously to assess trends in rates of coronary events. We carried out population surveys to estimate trends in risk factors. Trends in event rates were regressed on trends in risk score and in individual risk factors. FINDINGS: Smoking rates decreased in most male populations but trends were mixed in women; mean blood pressures and cholesterol concentrations decreased, bodymass index increased, and overall risk scores and coronary-event rates decreased. The model of trends in 10-year coronary-event rates against risk scores and single risk factors showed a poor fit, but this was improved with a 4-year time lag for coronary events. The explanatory power of the analyses was limited by imprecision of the estimates and homogeneity of trends in the study populations. INTERPRETATION: Changes in the classic risk factors seem to partly explain the variation in population trends in CHD. Residual variance is attributable to difficulties in measurement and analysis, including time lag, and to factors that were not included, such as medical interventions. The results support prevention policies based on the classic risk factors but suggest potential for prevention beyond these.

Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA project populations. Monitoring trends and determinants in cardiovascular disease.

BACKGROUND: The WHO MONICA (monitoring trends and determinants in cardiovascular disease) Project monitored, from the early 1980s, trends over 10 years in coronary heart disease (CHD) across 37 populations in 21 countries. We aimed to validate trends in mortality, partitioning responsibility between changing coronary-event rates and changing survival. METHODS: Registers identified non-fatal definite myocardial infarction and definite, possible, or unclassifiable coronary deaths in men and women aged 35-64 years, followed up for 28 days in or out of hospital. We calculated rates from population denominators to estimate trends in age-standardised rates and case fatality (percentage of 28-day fatalities=[100-survival percentage]). FINDINGS: During 371 population-years, 166,000 events were registered. Official CHD mortality rates, based on death certification, fell (annual changes: men -4.0% [range -10.8 to 3.2]; women -4.0% [-12.7 to 3.0]). By MONICA criteria, CHD mortality rates were higher, but fell less (-2.7% [-8.0 to 4.2] and -2.1% [-8.5 to 4.1]). Changes in non-fatal rates were smaller (-2.1%, [-6.9 to 2.8] and -0.8% [-9.8 to 6.8]). MONICA coronary-event rates (fatal and non-fatal combined) fell more (-2.1% [-6.5 to 2.8] and -1.4% [-6.7 to 2.8]) than case fatality (-0.6% [-4.2 to 3.1] and -0.8% [-4.8 to 2.9]). Contribution to changing CHD mortality varied, but in populations in which mortality decreased, coronary-event rates contributed two thirds and case fatality one third. INTERPRETATION: Over the decade studied, the 37 populations in the WHO MONICA Project showed substantial contributions from changes in survival, but the major determinant of decline in CHD mortality is whatever drives changing coronary-event rates.