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Martin Bobak

Publications and source records attributed to Martin Bobak.

At least 19 recordsLinked to original sources
PubMed2006

Determinants of cardiovascular disease and other non-communicable diseases in Central and Eastern Europe: rationale and design of the HAPIEE study.

BACKGROUND: Over the last five decades, a wide gap in mortality opened between western and eastern Europe; this gap increased further after the dramatic fluctuations in mortality in the former Soviet Union (FSU) in the 1990s. Recent rapid increases in mortality among lower socioeconomic groups in eastern Europe suggests that socioeconomic factors are powerful determinants of mortality in these populations but the more proximal factors linking the social conditions with health remain unclear. The HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe) study is a prospective cohort study designed to investigate the effect of classical and non-conventional risk factors and social and psychosocial factors on cardiovascular and other non-communicable diseases in eastern Europe and the FSU. The main hypotheses of the HAPIEE study relate to the role of alcohol, nutrition and psychosocial factors. METHODS AND DESIGN: The HAPIEE study comprises four cohorts in Russia, Poland, the Czech Republic and Lithuania; each consists of a random sample of men and women aged 45-69 years old at baseline, stratified by gender and 5 year age groups, and selected from population registers. The total planned sample size is 36,500 individuals. Baseline information from the Czech Republic, Russia and Poland was collected in 2002-2005 and includes data on health, lifestyle, diet (food frequency), socioeconomic circumstances and psychosocial factors. A short examination included measurement of anthropometric parameters, blood pressure, lung function and cognitive function, and a fasting venous blood sample. Re-examination of the cohorts in 2006-2008 focuses on healthy ageing and economic well-being using face-to-face computer assisted personal interviews. Recruitment of the Lithuanian cohort is ongoing, with baseline and re-examination data being collected simultaneously. All cohorts are being followed up for mortality and non-fatal cardiovascular events. DISCUSSION: The HAPIEE study will provide important new insights into social, behavioural and biological factors influencing mortality and cardiovascular risk in the region.

Aged↗
PubMed2006

The widening gap in mortality by educational level in the Russian Federation, 1980-2001.

OBJECTIVES: We examined trends in the relation between educational level and adult mortality in the Russian Federation in the period 1989 through 2001. METHODS: We used a convenience cohort based on survey respondents' information about age, survival status, and educational level of close relatives, and applied modified indirect demographic techniques to stratify mortality rates by educational level in the study period. A random sample of 7172 respondents (response rate=61%) provided full information on 10440 relatives. RESULTS: The mortality advantage of better-educated men and women in 1980 increased substantially by 2001. In 1980, life expectancy at age 20 for university-educated men was 3 years greater than for men with elementary education only, but was 11 years greater by 2001, reflecting not only declining life expectancy in less-educated men but also an improvement among better-educated men. Similar patterns were seen in women. CONCLUSIONS: The well-documented mortality increases seen in Russia after 1990 have predominantly affected less-educated men and women, whereas the mortality of persons with university education has improved, resulting in a sharp increase in educational-level mortality differentials.

Adult↗
PubMed2006

Depressive symptoms in urban population samples in Russia, Poland and the Czech Republic.

BACKGROUND: Relatively little is known about depression in countries that were formerly part of the Soviet Union, especially Russia. AIMS: To investigate the rates and distribution of depressive symptoms in urban population samples in Russia, Poland and the Czech Republic. METHOD: A cross-sectional study was conducted in randomly selected men and women aged 45-64 years (n=2151 in total, response rate 69%) in Novosibirsk (Russia), Krakow (Poland) and Karvina (Czech Republic). The point prevalence of depressive symptoms in the past week was defined as a score of at least 16 on the Center for Epidemiological Studies Depression scale. RESULTS: In men the prevalence of depressive symptoms was 23% in Russia, 21% in Poland and 19% in the Czech Republic; in women the rates were 44%, 40% and 34% respectively. Depressive symptoms were positively associated with material deprivation, being unmarried and binge drinking. The association between education and depression was inverse in Poland and the Czech Republic but positive in Russia. CONCLUSIONS: The prevalence of depressive symptoms in these eastern European urban populations was relatively high; as in other countries, it was associated with alcohol and several sociodemographic factors.

Alcohol Drinking↗
PubMed2005

Alcohol consumption and increased mortality in Russian men and women: a cohort study based on the mortality of relatives.

OBJECTIVE: To examine the relations between frequency of alcohol consumption and of binge drinking and adult mortality in Russian men and women. METHODS: Using modified indirect demographic techniques, a convenience cohort was constructed based on survey respondents' information about their close relatives. A random sample general population of the Russian Federation of 7172 respondents (response rate 61%) provided information on 10 475 male and 3129 female relatives, including age, vital status, and frequency of alcohol consumption and binge drinking. These relatives formed the cohort analysed in this report. The outcome measure was all-cause mortality after the age of 30 years. FINDINGS: There was a strong linear relation between frequency of drinking and of binge drinking and all-cause mortality in men; after controlling for smoking and calendar period of birth, the relative risk of death in daily drinkers compared to occasional drinkers was 1.52 (95% confidence interval (CI) 1.33-1.75). Male binge drinkers had higher mortality than drinkers who did not binge, which persisted after adjustment for drinking frequency (adjusted relative risk 1.09, 95% CI 1.00-1.19). In women, the increased mortality was confined to a small group of those who binged at least once a month (adjusted relative risk 2.68, 95% CI 1.54-4.66). CONCLUSION: The results suggest a positive association between alcohol and mortality in the Russian Federation. There was no evidence for the protective effect of drinking seen in western populations. Alcohol appears to have contributed to the high long-term mortality rates in Russian men, but it is unlikely to be a major cause of female mortality.

Adult↗
PubMed2005

Women's autonomy, education and contraception use in Pakistan: a national study.

BACKGROUND: It has been proposed that the autonomy of women is one of the mechanisms of how education influences contraceptive use in developing countries. We tested this hypothesis in a national sample of women in Pakistan. METHODS: We used the 2000 Pakistan Reproductive Health and Family Planning Survey, which interviewed a national sample of ever married women aged 15-49 years (n = 6579). Women's decision autonomy was estimated from 9 questions on who makes decisions at home; movement autonomy was based on 6 questions on whether women need permission to visit places outside home. A number of socio-demographic variables were used in multivariate analysis to investigate the independent association between autonomy and lifetime and current contraception use and to assess the extent to which autonomy mediates the association between education and contraception use. RESULTS: Decision autonomy was significantly associated with both lifetime and current contraception use; after controlling for covariates, the odds ratios for the highest vs. the lowest quintile were 1.8 (1.4-2.4) and 2.0 (1.4-2.8), respectively. Movement autonomy was not consistently associated with contraceptive use. Contraceptive use was strongly associated with women's education but this relation was not mediated by women's autonomy. CONCLUSION: Women's decision autonomy is significantly associated with contraceptive use but it does not appear to mediate the link between woman's education and contraception.

Journal Article↗
PubMed2005

Unfavourable birth outcomes of the Roma women in the Czech Republic and the potential explanations: a population-based study.

BACKGROUND: Data on the health status of the Roma people in Central and Eastern Europe are sparse and the reasons for their poor health are not clear. The objective of this study was to quantify the differences in birth outcomes between Roma and non-Roma mothers in the Czech Republic and to investigate the potential causes of such differences. METHOD: A population-based study recruited 8938 non-Roma and 1388 Roma hospitalised singleton births that occurred in two Czech districts (Teplice and Prachatice) between 1995 and 2004. During their stay in hospital, mothers completed a questionnaire on their demographic and socioeconomic characteristics and maternal smoking and alcohol consumption. Data on maternal height and weight and on infants' birth weight and gestational age were taken from hospital records. RESULTS: Birth weight and gestational age of Roma infants was 373 (SE 15) g and 0.92 (0.05) weeks, respectively, lower than in non-Roma infants. Controlling for demographic, socioeconomic and behavioural factors reduced these differences to 133 (18) g and 0.57 (0.06) weeks, respectively (all p-values < 0.001). In terms of binary outcomes, the Roma vs. non-Roma odds ratios were 4.5 (95% CI 3.7-5.4) for low birth weight (< 2500 g), 2.8 (2.2-3.4) for preterm birth (< 37 weeks of gestation), and 2.9 (2.5-3.4) for intrauterine grown retardation (<10th percentile of birth weight for gestational age); controlling for all covariates reduced these odds ratios to 1.7 (1.3-2.2), 1.5 (1.1-2.0) and 1.3 (1.0-1.6), respectively. Maternal education made the largest contribution to the ethnic differences; the role of health behaviours was relatively modest. CONCLUSION: There are striking differences in birth outcomes between Roma and non-Roma mothers. The causes of these differences are complex but largely socioeconomic.

Adolescent↗
PubMed2005

Socio-economic influences on self-rated health in Russian men and women--a life course approach.

Socio-economic differentials in health in Russia are not well understood and the life course approach has been relatively neglected. This paper examines the influence of socio-economic risk factors over the life course on the self-rated health of older Russian men and women. A random sample (response rate 61%) of the general population of the Russian Federation in 2002 included 1004 men and 1930 women aged 50 years and over in a cross-sectional study. They provided information concerning their childhood circumstances, including going to bed hungry; education; current social conditions, including per capita household income; health behaviours and self-rated health. There was considerable tracking of adverse social conditions across the life course with men and women who reported hunger in childhood having lower educational achievements, and current household income was strongly influenced by educational attainment. The effect of these socio-economic risk factors on health accumulated with an odds ratio of poor health of 1.87 [1.07-3.28] for men with one risk factor, 3.64 [2.13-6.22] for two risk factors and 4.51 [2.57-7.91] for all three compared to men with no risk factors. For women, the odds ratios were 1.44 [1.05-2.01], 2.88 [2.10-3.93] and 4.27 [3.03-6.00] for one, two and three risk factors, respectively. Current income was the strongest individual predictor for men, and education for women. Adjustment for health behaviours reduced the odds ratios only marginally. The results suggest that self-rated health in older Russians reflects social exposures accumulated over the life course, with the differentials observed only partially explained by current social conditions. Health behaviours were not involved in mediating social differences in self-rated health. Our results indicate that a life course approach may contribute to the understanding of health in Russia.

Adolescent↗
PubMed2005

Do lipids contribute to the lack of cardio-protective effect of binge drinking: alcohol consumption and lipids in three eastern European countries.

AIMS: The cardio-protective effect of moderate alcohol consumption is partly mediated by HDL cholesterol. However, epidemiological studies suggest that binge drinking may not be associated with reduced risk of heart disease; a possible explanation is that the relationship of blood lipids with binge drinking is different from that with moderate intake. We investigated this hypothesis in a population study in three eastern European countries. METHODS: We conducted a cross-sectional study in random population samples in Novosibirsk (Russia), Krakow (Poland) and Karvina (Czech Republic). A sub-sample of 282 men aged 45-64 years who provided a fasting blood sample were analysed. Annual alcohol intake and the frequency of heavy binge drinking (> or =140 g of ethanol per session) were estimated from a graduated frequency questionnaire. RESULTS: Annual intake of alcohol was positively associated with total and HDL cholesterol. After controlling for annual intake, the frequency of heavy binge drinking was associated with increased concentrations of total and HDL cholesterol. By combining annual intake and drinking pattern, we found that men consuming >8 l of alcohol per year who had a heavy binge at least once a month had the mean total, HDL and LDL cholesterol 1.69 (SE 0.35), 0.61 (0.11) and 0.97 (0.34) mmol/l, respectively, higher than non-drinkers; this resulted in more favourable ratios of total and LDL cholesterol relative to HDL cholesterol in frequent heavy bingers. Triglycerides were not related to alcohol intake or binge drinking. CONCLUSIONS: Blood lipids do not seem to explain the apparent lack of the cardio-protective effect of binge drinking reported in epidemiological studies.

Alcoholic Intoxication↗
PubMed2005

Ambient air pollution and pregnancy outcomes: a review of the literature.

Over the last decade or so, a large number of studies have investigated the possible adverse effects of ambient air pollution on birth outcomes. We reviewed these studies, which were identified by a systematic search of the main scientific databases. Virtually all reviewed studies were population based, with information on exposure to air pollution derived from routine monitoring sources. Overall, there is evidence implicating air pollution in adverse effects on different birth outcomes, but the strength of the evidence differs between outcomes. The evidence is sufficient to infer a causal relationship between particulate air pollution and respiratory deaths in the postneonatal period. For air pollution and birth weight the evidence suggests causality, but further studies are needed to confirm an effect and its size and to clarify the most vulnerable period of pregnancy and the role of different pollutants. For preterm births and intrauterine growth retardation (IUGR) the evidence as yet is insufficient to infer causality, but the available evidence justifies further studies. Molecular epidemiologic studies suggest possible biologic mechanisms for the effect on birth weight, premature birth, and IUGR and support the view that the relation between pollution and these birth outcomes is genuine. For birth defects, the evidence base so far is insufficient to draw conclusions. In terms of exposure to specific pollutants, particulates seem the most important for infant deaths, and the effect on IUGR seems linked to polycyclic aromatic hydrocarbons, but the existing evidence does not allow precise identification of the different pollutants or the timing of exposure that can result in adverse pregnancy outcomes.

Air Pollution↗
PubMed2004

Life span and disability: a cross sectional comparison of Russian and Swedish community based data.

OBJECTIVES: To compare levels of disability (in terms of physical function and self rated health) among middle aged and elderly people in Russia and Sweden, a country with high life expectancy. DESIGN: Cross sectional study. SETTING: General population of the Russian Federation and of two counties in southern Sweden. PARTICIPANTS: Randomly selected men and women in Sweden (n = 9489) and Russia (n = 1599). MAIN OUTCOME MEASURES: Official life table data; self rated health and physical functioning (subscale of the SF-36). RESULTS: The official life table data showed large differences in mortality--for example, 36% of Russian men aged 45-49 years would survive the next 25 years compared with 75% of Swedish men. The survey data showed, for both sexes, similar levels of self rated health and physical functioning in the two countries up to the age of about 45 years, but after that, the age related decline in both outcomes was much faster in Russia than in Sweden. By combining the national life tables with survey data on physical functioning we estimated that in the age group 45-49 years, 99% of Russian and 97% of Swedish men would be free of disability; of these, if these data were for a cohort, only 17% of Russians would be alive and free of disability 25 years later compared with 65% of Swedes. The difference in survival was similar in women. CONCLUSIONS: Large differences exist in survival without disability between elderly Russians and Swedes. The short life span in Russia reflects high levels of ill health and disability and is associated with a rapid age related decline in physical functioning.

Adult↗
PubMed2004

Relation between children's height and outdoor air pollution from coal-burning sources in the British 1946 birth cohort.

OBJECTIVE: Air pollution is associated with a number of health outcomes in childhood. In this study, we investigated whether air pollution is related to children's height. METHODS: The 1946 British birth cohort study recruited 5,362 children born in 1 week in March 1946. Height was measured when the children were aged 2, 4, 6, 7, 11 and 15 years. Data on socio-economic conditions and other characteristics were obtained in interviews. Areas of children's residence were categorised into four groups of air pollution on the basis of published coal-consumption data. RESULTS: After controlling for socio-economic factors, we found that air pollution was associated with children's height at several ages. The association, adjusted for socio-economic factors, was strongest at the age of 7 years, when children in the most polluted areas were 1.2 (95% confidence interval 0.5-1.8) cm shorter than those in the least polluted areas. After the age of 7 years the effect of air pollution diminished and disappeared by the age of 15 years. Further adjustment for birth weight and respiratory illness in childhood did not change this pattern. CONCLUSIONS: Children's height was inversely associated with air pollution, but the magnitude of the effect depended on age. However, the biological mechanisms linking children's growth with air pollution are not evident, and it remains to be confirmed whether the relationship is genuine and causal.

Adolescent↗
PubMed2004

Psychosocial factors at work and depression in three countries of Central and Eastern Europe.

Psychosocial factors at work have been found to predict a range of health outcomes but their effect on mental health outcomes has not been extensively studied. This paper explores the relationship between psychosocial factors at work and depression in three countries of Central and Eastern Europe. The data come from a cross-sectional study of working men (n = 645) and women (n = 523) aged 45-64 years, randomly selected from population registers in Novosibirsk (Russia), Krakow (Poland) and Karvina-Havirov (Czech Republic). The questionnaire included questions on the effort and reward at work, job control, the full CES-D scale of depression, and a range of other characteristics. Linear regression was used to estimate the association between depression score and work characteristics: the logarithm of the effort-reward ratio, and continuous job control score. The means of the depression score were 10.5 for men and 14.2 for women. After controlling for age, sex and country, effort-reward ratio (logarithmically transformed) was strongly related to depression score; a 1 SD increase in the log transformed effort-reward ratio was associated with an increase in the depression of 2.0 points (95% CI 1.5; 2.4), and further adjustment did not materially change the effect. Job control was inversely associated with depression score in Poland and the Czech Republic (not in Russia) but the association was largely eliminated by controlling for socioeconomic characteristics. This study suggests that the effort-reward imbalance at work is related to prevalence of depression in these central and eastern European populations.

Aged↗
PubMed2004

Education, marital status, and total and cardiovascular mortality in Novosibirsk, Russia: a prospective cohort study.

PURPOSE: Mortality from cardiovascular diseases in Russia is among the highest in the world but little is known about its distribution by socio-demographic factors. We investigated this question in a prospective cohort study based on the Novosibirsk MONICA Project. METHOD: The cohort consisted of 6485 men and 4919 women aged 25 to 64 years at baseline, examined in 4 surveys in 1984, 1985/86, 1988/89, and 1994/95, and followed up for an average 10.3 (range 3.1-15.2) years. Participants reported their education and marital status in a questionnaire; the information on risk factors was collected in a short medical examination. RESULTS: A total of 836 male and 226 female deaths occurred during the follow up. High education was associated with reduced mortality from all causes, cardiovascular disease, and coronary heart disease in both genders. Age-adjusted relative risk of death from cardiovascular diseases for university vs. primary education was 0.6 (0.4-0.8) in men and 0.4 (0.2-0.8) in women. Adjustment for coronary risk factors and marital status substantially reduced the relative risk in men but not in women. There was no consistent relation between education and stroke. Unmarried men had higher mortality from all causes, cardiovascular and coronary heart disease than married subjects; the increased risk of divorced men was not explained by coronary risk factors or low education. Unmarried women had higher all-cause mortality than married women but associations between marital status and cardiovascular diseases were inconsistent. CONCLUSION: The educational differences in total and cardiovascular mortality in Russia are of similar direction and magnitude as in western populations. The educational differences in cardiovascular mortality in women and the increased mortality of divorced men were not explained by classical risk factors.

Adult↗
PubMed2003

Household item ownership and self-rated health: material and psychosocial explanations.

BACKGROUND: There has been an ongoing debate whether the effects of socioeconomic factors on health are due to absolute poverty and material factors or to relative deprivation and psychosocial factors. In the present analyses, we examined the importance for health of material factors, which may have a direct effect on health, and of those that may affect health indirectly, through psychosocial mechanisms. METHODS: Random national samples of men and women in Hungary (n = 973) and Poland (n = 1141) were interviewed (response rates 58% and 59%, respectively). The subjects reported their self-rated health, socioeconomic circumstances, including ownership of different household items, and perceived control over life. Household items were categorised as "basic needs", "socially oriented", and "luxury". We examined the association between the ownership of different groups of items and self-rated health. Since the lists of household items were different in Hungary and Poland, we conducted parallel identical analyses of the Hungarian and Polish data. RESULTS: The overall prevalence of poor or very poor health was 13% in Poland and 25% in Hungary. Education, material deprivation and the number of household items were all associated with poor health in bivariate analyses. All three groups of household items were positively related to self-rated health in age-adjusted analyses. The relation of basic needs items to poor health disappeared after controlling for other socioeconomic variables (mainly material deprivation). The relation of socially oriented and luxury items to poor health, however, persisted in multivariate models. The results were similar in both datasets. CONCLUSIONS: These data suggest that health is influenced by both material and psychosocial aspects of socioeconomic factors.

Adult↗
PubMed2003

Do health control beliefs predict behaviour in Russians?

BACKGROUND: Unhealthy lifestyles contribute substantially to Russia's high mortality. Health control beliefs influence lifestyles to some extent in the West but this relationship is not well studied in Russia. METHOD: Data from a 1996 cross-sectional interview study in a multistage random Russian population sample (n=1599, response rate 66%) were analysed. These were belief in the ability to influence general health, risk of heart attack, or cancer; the prevalence of smoking, drinking alcohol several times weekly, binge drinking (>80 g alcohol per occasion), and obesity (self-reported body mass index >30); and several social characteristics. RESULTS: Believing one could influence one's health (prevalence 63%) and reduce the risk of a heart attack (42%) and cancer (30%) was associated with younger age, male sex, and higher income after controlling for other socioeconomic factors. Associations between health control beliefs and behaviours were generally weak and inconsistent. Men believing they could influence their general health were somewhat less likely to smoke or drink regularly. Fewer women who believed that they could reduce their risk of cancer were obese. CONCLUSIONS: Health control beliefs, commoner in younger and better off Russians, were weakly related to behaviours. This has implications for designing interventions to change health behaviours in Russia.

Adolescent↗
PubMed2003

Relative and absolute gender gap in all-cause mortality in Europe and the contribution of smoking.

This paper examined whether international variations in absolute and relative gender differences in mortality are related to the overall mortality rates, and whether the international variation in gender gap in mortality can in part be explained by smoking. I used data on mortality from all causes in 32 European countries published by the World Health Organisation, and indirect estimates of mortality attributable to smoking in the age band 35-69 years by Peto et al. The main analyses were restricted to the age band 35-69 years but results for mortality at all ages were virtually identical. The overall mortality rates (both sexes combined) were strongly related to absolute gender differences (r = 0.91) but only weakly to relative differences (r = 0.35). The gender gap was larger in eastern than in western Europe for rate differences (1005 vs. 530 per 100,000, respectively), but it was similar for rate ratios (2.3 vs. 2.1, respectively). Both absolute and relative gender differences in mortality were strongly related to the difference between men and women in the proportion of all deaths attributed to tobacco (partial correlations, after controlling for the overall death rates, were 0.59 and 0.66, respectively). Excluding tobacco-related deaths attenuated the associations between the overall mortality rates with absolute differences (r = 0.70) and reduced the difference in the absolute gender gap between eastern and western Europe. More importantly, excluding tobacco-related deaths eliminated entirely the association with relative differences (r = -0.15) as well as any suggestion that the relative gender gap is larger in eastern than in western Europe. These results show that tobacco plays an important role in generating international differences in the size of gender gap in mortality. The much discussed association between' the overall life expectancy and the gender gap in life expectancy is a numerical product of absolute death rates (differences in life expectancy are driven by differences in rates). The association of overall mortality with male/female mortality ratios is much weaker.

Adult↗
PubMed2003

Determinants of adult mortality in Russia: estimates from sibling data.

OBJECTIVES: It would be useful to have a quick and cost-effective method to study individual-level determinants of mortality in countries where reliable data are not available. We have modified indirect demographic methods and applied them to a population sample to investigate predictors of mortality in Russia. METHODS: A national sample of the Russian population was interviewed in a cross-sectional survey. The participants were asked about characteristics of their eldest siblings, including their vital status, year of birth, and year of death (if deceased). The association between personal characteristics and mortality risk was estimated for 682 male and 698 female siblings (of whom 122 and 81, respectively, had died). RESULTS: In both sexes, mortality was strongly associated with smoking and low education. After adjustment for smoking and education, mortality was elevated in men and women who drank alcohol at least once a month. Mortality was also higher among in men who had been binge drinking (more than half a bottle of vodka per drinking session) at least once a week (adjusted risk ratio [RR] = 2.5; 95% confidence interval [CI] = 1.2-4.9) and in women who were binging at least once a month (RR = 3.9; CI = 1.1-14.5) compared with nonbinging. SUBJECTS: Similar associations with drinking were seen for cardiovascular deaths in men. Childhood social circumstances were not associated with mortality. CONCLUSIONS: The study of siblings appears to be a cost-effective alternative for estimating risk factors for mortality in literate populations. This study identified smoking, low education, and alcohol consumption (especially binge drinking) as risk factors for mortality in Russia.

Adult↗