Abstract |
Background Behavioral risk factors (BRFs) refer to lifestyle habits such as smoking,
physical inactivity, risky alcohol consumption and high body weight. Individually or
in clusters, they contribute cumulatively to the development of non-communicable
diseases and especially to cardiovascular disease, diabetes mellitus, chronic
obstructive pulmonary disease, arthritis and certain types of cancer.
Aim The aim of this study was to assess the prevalence of individual BRFs and
multiple BRFs in adults, aged 50+ from eleven European countries (SHARE study),
according to i) their basic characteristics and ii) the potential differences in BRF
accumulation between the different countries/regions. Moreover, we assessed the
association of BRF presence with: iii) physical and mental health status, iv) preventive
health services utilization and v) religious and spiritual beliefs.
Subjects and methods We used a subset of data from the 1st wave (2004/5) of the
“Survey of Health, Ageing and Retirement in Europe” (SHARE), from eleven
European countries: Austria, Belgium, Denmark, France, Germany, Greece, Italy,
Netherlands, Spain, Sweden and Switzerland. The SHARE Survey is organized and
coordinated by Mannheim Research Institute for the Economics of Ageing (MEA,
Germany), in collaboration with >60 research teams, including the Faculty of Social
Medicine of the University of Crete. The selected sample in the current study
consisted of 26,743 individuals aged 50+ years, and corresponds to a target estimated
population of 105 million. The studied population was selected according to the
complex multistage stratification design in order to be representative of the European
population aged over 50 years. Response rates ranged from 73.7% (Spain) to 93.3%
(France). Validated questionnaires were used that assessed demographic
characteristics, physical and mental health, social activities, behavioral risks etc. The
prevalence of four BRFs (1: presence, 0: absence) in adults was also assessed as the
presence of high body weight (overweight/obese), smoking, physical inactivity and
risky alcohol consumption. For the estimation of the prevalence of BRFs accumulation
(multiple clustering), an average clustering or mean factors, score was calculated by
adding up the number of individual BRFs, whereas the accumulation of 2+ risk factors
was considered to be an indication of increased risk for chronic diseases. Moreover,
we used participants’ social and demographic characteristics, their morbidity status,
their utilization of preventive health services and their religious and spiritual beliefs.
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Data were analyzed using the IBM-SPSS v21.0. Weights were applied according to
the complex sampling design of the study, reflecting non-responses and stratification
design. The prevalence of BRFs and the respective 95% confidence intervals (95%
CIs) were estimated according to the complex sampling design and/or by bootstrap
techniques. Throughout the complex samples procedure, multivariate regression
models were applied, estimating differences and relationships. Moreover, in regional
differences, simple correspondence analysis was used to graphically illustrate the
accumulation of BRFs in the eleven participating countries.
Results In total, 71.2% of participants were physically inactive, while 59.8% had high
body weight. 53.4% had 2+ MBRFs, while males presented higher prevalence of
BRFs clusters than females (58.5% vs. 49.0%, p<0.001). Females displayed lower
odds of increased alcohol consumption (OR=0.16, p<0.001) and higher odds of
physical inactivity (OR=1.47, p<0.001) than males. Participants who lived alone,
compared to those living with a partner, and those with more, compared to fewer
education years, exhibited a significantly higher and lower, respectively, mean BRFs
score (p<0.001).
The cluster of ‘high body weight and physical inactivity’ had the highest prevalence of
BRFs (35.4%), with higher prevalence in Southern Europe (p<0.05). The ‘smoking
and alcohol consumption’ cluster presented the greatest degree of multiple BRF
clustering (observed to expected ratio=2.44). Participants from Southern European
countries had a higher mean number of BRFs (p<0.05), whereas the highest
prevalence of clustering (2+ BRFs) was observed in Spain (61.65) and Greece (60.6%)
(p<0.05).
With regards to physical and mental health status, physically inactive adults had, in
comparison to their counterparts, a higher mean number of conditions (1.33 vs. 1.26,
p=0.009), whereas risky drinkers had a higher mean score in the depression scale (2.84
vs. 2.47, p=0.003). Adults with 2+ BRFs had significantly higher odds of having 1+
condition (males:1.52; 95%CI,1.20-1.91, females:1.73; 95%CI,1.42-2.12), compared
to those with 0-1 BRFs. Adults with 2+ BRFs also had significantly higher prevalence
of ‘high blood pressure or hypertension’ (37.8%; 95%CI,36.4-39.1; vs. 28.2%;
95%CI,26.9-29.6). Among participants presenting with 2+ BRFs, Belgian adults had
the highest mean number of chronic diseases and/or functional limitations and
symptoms.
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With regards to preventive health services utilization (PHSU), adults with high body
weight had a lower odds ratio for seeing a dentist/dental hygienist (0.75, p<0.05) or
having sigmoidoscopy-colonoscopy (0.70, p<0.05) and higher odds of receiving
advice by a general practitioner (GP) to get regular exercise (1.56, p<0.05). Smokers
had lower odds of having a mammogram (0.76, p<0.05) or detecting hidden blood in
stool (0.63, p<0.05). Adults with high body weight (p=0.001), smokers (p=0.001) and
risky drinkers (p=0.008) had a lower mean score of PHSU, while the PHSU score did
not differ according to clustering of the BRFs (p=0.218). Among adults with 2+ BRFs
from all participating countries, the lowest mean score of PHSU was found in Greece
with 28.0 (p<0.05).
Finally, and with regards to prayer use, lower prevalence of smoking was found in
males (20.6% vs. 29.4%, p<0.05), as well as in females (13.1% vs. 22.6%, p7lt;0.05)
who prayed ‘≥1 time/day’, compared to those who never prayed. Categorical
regression analysis revealed that the presence of 2+ BRFs was negatively associated
with religious education (standardized beta=-0.048, p<0.001) and positively with low
frequency of prayer use (standardized beta=0.056, p7lt0.001).
Conclusion The prevalence of BRFs for chronic diseases was considerably high in
this sample of European adults, and higher in Southern European countries.
Individually or in clusters, BRFs were related with indexes of physical and mental
health, whereas they seem to contribute to less preventive health services utilization.
Nevertheless, a lower presence of BRFs is associated with the presence of co-habiting,
higher education levels or religious and spiritual beliefs. These findings can be used
for the design of multi-ethnic primary healthcare programs by health professionals, in
order to reduce the adoption and prevalence of BRFs, thus contributing to health
promotion at the population level.
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