Daniel J Corsi

Publications (18)117.06 Total impact

• Article: Jumping the gun: the problematic discourse on socioeconomic status and cardiovascular health in India.

  Sv Subramanian, Daniel J Corsi, Malavika A Subramanyam, George Davey Smith
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  ABSTRACT: There has been an increased focus on non-communicable diseases (NCDs) in India, especially on cardiovascular diseases and associated risk factors. In this essay, we scrutinize the prevailing narrative that cardiovascular risk factors (CVRF) and cardiovascular disease (CVD) are no longer confined to the economically advantaged groups but are an increasing burden among the poor in India. We conducted a comprehensive review of studies reporting the association between socioeconomic status (SES) and CVRF, CVD, and CVD-related mortality in India. With the exception of smoking and low fruit and vegetable intake, the studies clearly suggest that CVRF/CVD is more prevalent among high SES groups in India than among the low SES groups. Although CVD-related mortality rates appear to be higher among the lower SES groups, the proportion of deaths from CVD-related causes was found to be greatest among higher SES groups. The studies on SES and CVRF/CVD also reveal a substantial discrepancy between the data presented and the authors' interpretations and conclusions, along with an unsubstantiated claim that a reversal in the positive SES-CVRF/CVD association has occurred or is occurring in India. We conclude our essay by emphasizing the need to prioritize public health policies that are focused on the health concerns of the majority of the Indian population. Resource allocation in the context of efforts to make health care in India free and universal should reflect the proportional burden of disease on different population groups if it is not to entrench inequity.
  International Journal of Epidemiology 04/2013; · 6.41 Impact Factor
• Article: Co-variation in dimensions of smoking behaviour: A multivariate analysis of individuals and communities in Canada.

  Daniel J Corsi, S V Subramanian, Scott A Lear, Clara K Chow, Koon K Teo, Michael H Boyle
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  ABSTRACT: We evaluated the effects of socioeconomic status on the prevalence of current smoking, number of cigarettes smoked per day and pack-years, and the extent to which prevalence and consumption co-vary across communities, health regions, and provinces in Canada between 2001 and 2010. Current smoking, cigarettes per day, and pack-years were considered as outcomes within individuals using a multilevel analytical framework. Markers of SES were education, income, and occupation. Residual covariance estimated at the different levels of geography was used to determine if areas high in current smoking were also high on levels of consumption. A strong inverse gradient was found between education and current smoking and level of consumption with large variation found in levels of consumption between individual smokers. The co-variation between current smoking and level of consumption was positive and statistically significant at the level of communities and health regions. Our findings suggest that novel policy efforts may be needed to encourage smoking prevention/cessation among certain population groups and in places with high levels of smoking prevalence and tobacco use intensity.
  Health & Place 03/2013; 22C:29-37. · 2.67 Impact Factor
• Article: Commentary: Challenges to establishing the link between birthweight and cognitive development.

  Daniel J Corsi, George Davey Smith, S V Subramanian
  International Journal of Epidemiology 02/2013; 42(1):172-175. · 6.41 Impact Factor
• Article: Change in the Body Mass Index Distribution for Women: Analysis of Surveys from 37 Low- and Middle-Income Countries.

  Fahad Razak, Daniel J Corsi, Sv Subramanian
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  ABSTRACT: BACKGROUND: There are well-documented global increases in mean body mass index (BMI) and prevalence of overweight (BMI≥25.0 kg/m(2)) and obese (BMI≥30.0 kg/m(2)). Previous analyses, however, have failed to report whether this weight gain is shared equally across the population. We examined the change in BMI across all segments of the BMI distribution in a wide range of countries, and assessed whether the BMI distribution is changing between cross-sectional surveys conducted at different time points. METHODS AND FINDINGS: We used nationally representative surveys of women between 1991-2008, in 37 low- and middle-income countries from the Demographic Health Surveys ([DHS] n = 732,784). There were a total of 96 country-survey cycles, and the number of survey cycles per country varied between two (21/37) and five (1/37). Using multilevel regression models, between countries and within countries over survey cycles, the change in mean BMI was used to predict the standard deviation of BMI, the prevalence of underweight, overweight, and obese. Changes in median BMI were used to predict the 5th and 95th percentile of the BMI distribution. Quantile-quantile plots were used to examine the change in the BMI distribution between surveys conducted at different times within countries. At the population level, increasing mean BMI is related to increasing standard deviation of BMI, with the BMI at the 95th percentile rising at approximately 2.5 times the rate of the 5th percentile. Similarly, there is an approximately 60% excess increase in prevalence of overweight and 40% excess in obese, relative to the decline in prevalence of underweight. Quantile-quantile plots demonstrate a consistent pattern of unequal weight gain across percentiles of the BMI distribution as mean BMI increases, with increased weight gain at high percentiles of the BMI distribution and little change at low percentiles. Major limitations of these results are that repeated population surveys cannot examine weight gain within an individual over time, most of the countries only had data from two surveys and the study sample only contains women in low- and middle-income countries, potentially limiting generalizability of findings. CONCLUSIONS: Mean changes in BMI, or in single parameters such as percent overweight, do not capture the divergence in the degree of weight gain occurring between BMI at low and high percentiles. Population weight gain is occurring disproportionately among groups with already high baseline BMI levels. Studies that characterize population change should examine patterns of change across the entire distribution and not just average trends or single parameters. Please see later in the article for the Editors' Summary.
  PLoS Medicine 01/2013; 10(1):e1001367. · 16.27 Impact Factor
• Article: Socioeconomic and geographic patterning of smoking behaviour in Canada: a cross-sectional multilevel analysis.

  Daniel J Corsi, Scott A Lear, Clara K Chow, S V Subramanian, Michael H Boyle, Koon K Teo
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  ABSTRACT: To describe the socioeconomic and geographic distribution of smoking behaviour in Canada among 19,383 individuals (51% women) aged 15-85 years. Current smoking and quitting were modeled using standard and multilevel logistic regression. Markers of socioeconomic status (SES) were education and occupation. Geography was defined by Canadian Provinces. The adjusted prevalence of current smoking was 20.2% (95% confidence interval [CI]: 18.8-21.7) and 63.7% (95% CI: 61.1-66.3) of ever smokers had quit. Current smoking decreased and quitting increased with increasing SES. The adjusted prevalence of current smoking was 32.8% (95% CI: 28.4-37.5) among the least educated compared to 11.0% (95% CI: 8.9-13.4) for the highest educated. Among the least educated, 53.0% (95% CI: 46.8-59.2) had quit, rising to 68.7% (95% CI: 62.7-74.1) for the most educated. There was substantial variation in current smoking and quitting at the provincial level; current smoking varied from 17.9% in British Columbia to 26.1% in Nova Scotia, and quitting varied from 57.4% in Nova Scotia to 67.8% in Prince Edward Island. Nationally, increasing education and occupation level were inversely associated with current smoking (odds ratio [OR] 0.64, 95% CI: 0.60-0.68 for education; OR 0.82, 95% CI: 0.77-0.87 for occupation) and positively associated with quitting (OR 1.27, 95% CI: 1.16-1.40 for education; OR 1.20, 95% CI: 1.12-1.27 for occupation). These associations were consistent in direction across provinces although with some variability in magnitude. Our findings indicate that socioeconomic inequalities in smoking have persisted in Canada; current smoking was less likely and quitting was more likely among the better off groups and in certain provinces. Current prevention and cessation policies have not been successful in improving the situation for all areas and groups. Future efforts to reduce smoking uptake and increase cessation in Canada will need consideration of socioeconomic and geographic factors to be successful.
  PLoS ONE 01/2013; 8(2):e57646. · 4.09 Impact Factor
• Article: Smoking in context: a multilevel analysis of 49,088 communities in Canada.

  Daniel J Corsi, Clara K Chow, Scott A Lear, S V Subramanian, Koon K Teo, Michael H Boyle
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  ABSTRACT: The extent to which the prevalence of smoking in Canada varies across geographic areas independently of individual characteristics has not been quantified. To estimate the extent and potential sources of geographic variation in smoking among communities, health regions, and provinces/territories in Canada. Data are from the Canadian Community Health Surveys conducted between 2001 and 2008 (n=461,709). Current cigarette smoking among adults (aged ≥18 years) was the primary outcome. Individual-level markers of SES were education, household income, and occupation. Contextual variables potentially related to smoking considered were provincial cigarette taxes, workplace smoking bans, and collective family norms discouraging smoking in communities. A multilevel logistic regression analysis was conducted to model variation in smoking at the geographic scale of communities, health regions, and provinces. Overall, the contribution of geography as a percentage of the total variation in smoking was 8.4%, with 2.4% attributable to provinces, 1.2% attributable to health regions, and 4.8% attributable to communities after adjusting for age, gender and survey period. In models that accounted for socioeconomic and demographic characteristics in addition to age and gender, the contribution of geography to the total variation in smoking was attenuated to 4.1%; with 2.0% at the province level, 0.4% at the health region level, and 1.7% at the community level. Within provinces/territories, the community variation in smoking ranged from 2.4% in Prince Edward Island to 9.1% in British Columbia. Nationally, 71% of community and 21% of provincial differences in smoking were explained by individual, socioeconomic, and demographic factors alone; the inclusion of contextual covariates explained an additional 27% of the variation among communities. Collective family norms discouraging smoking in a community was the strongest contextual predictor of individual smoking; provincial cigarette taxes and workplace bans were only modestly related to individual smoking behavior. Geographic variation in smoking remained after accounting for individual, socioeconomic, and demographic characteristics, suggesting the importance of place, at the level of provinces and communities in Canada. Remaining community variation in smoking was largely attenuated after accounting for collective family norms discouraging smoking. Area-level influences such as the social and/or environmental conditions of provinces and communities may be important sources of variation in smoking and therefore need to be considered if rates of smoking are to be modified.
  American journal of preventive medicine 12/2012; 43(6):601-10. · 4.24 Impact Factor
• Article: Demographic and health surveys: a profile.

  Daniel J Corsi, Melissa Neuman, Jocelyn E Finlay, Sv Subramanian
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  ABSTRACT: Demographic and Health Surveys (DHS) are comparable nationally representative household surveys that have been conducted in more than 85 countries worldwide since 1984. The DHS were initially designed to expand on demographic, fertility and family planning data collected in the World Fertility Surveys and Contraceptive Prevalence Surveys, and continue to provide an important resource for the monitoring of vital statistics and population health indicators in low- and middle-income countries. The DHS collect a wide range of objective and self-reported data with a strong focus on indicators of fertility, reproductive health, maternal and child health, mortality, nutrition and self-reported health behaviours among adults. Key advantages of the DHS include high response rates, national coverage, high quality interviewer training, standardized data collection procedures across countries and consistent content over time, allowing comparability across populations cross-sectionally and over time. Data from DHS facilitate epidemiological research focused on monitoring of prevalence, trends and inequalities. A variety of robust observational data analysis methods have been used, including cross-sectional designs, repeated cross-sectional designs, spatial and multilevel analyses, intra-household designs and cross-comparative analyses. In this profile, we present an overview of the DHS along with an introduction to the potential scope for these data in contributing to the field of micro- and macro-epidemiology. DHS datasets are available for researchers through MEASURE DHS at www.measuredhs.com.
  International Journal of Epidemiology 11/2012; · 6.41 Impact Factor
• Article: Weight of communities: a multilevel analysis of body mass index in 32,814 neighborhoods in 57 low- to middle-income countries (LMICs).

  Daniel J Corsi, Jocelyn E Finlay, S V Subramanian
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  ABSTRACT: The extent to which body mass index (BMI) varies between small areas or neighborhoods in low- to middle-income countries (LMICs) remains unknown. Further, whether such variation is reflective of characteristics of individuals living in these neighborhoods is also not clear. We estimated the extent to which there is variation in BMI is attributable to neighborhoods in 57 LMICs. The data were from non-pregnant women of reproductive age (20-49 y) participating in Demographic and Health Surveys conducted in 57 countries between 1994 and 2008. Body mass index (BMI, weight [in kg] divided by height squared [in m(2)]) was used to assess weight status. Height and weight were measured objectively by trained field investigators. Age, household wealth, education were included as individual covariates and place of residence (urban or rural) as a neighborhood-level covariate. We conducted a multilevel analysis of 451,321 women (aged 20-49 y) from 32,814 neighborhoods and 57 countries. We used linear and multinomial models to partition the variation in BMI (in kg/m(2)), underweight (BMI <18.5 kg/m(2)) and overweight (BMI ≥25.0 kg/m(2)) at the level of neighborhoods and countries. We also explored the heterogeneity in neighborhood variation by socioeconomic status (SES). Of the total variation in BMI 17.6% was attributable to countries (Standard Deviation [SD] 2.0, 95% credible interval [CI] 1.7, 2.4) and 10.6% (SD 1.56, 95% CI 1.54, 1.58) was attributable to neighborhoods in age-adjusted models. Adjusting for individual- and neighborhood-level covariates reduced the SD attributable to countries and neighborhoods to 1.9, and 1.17, respectively. Between-country variation was 13.4% (SD 0.75, 95% CI 0.62-0.90) for underweight and 18.9% (SD 0.92, 95% CI 0.76-1.10) for overweight, and between-neighborhood variation was 7.7% (SD 0.57, 95% CI 0.55-0.58) for underweight and 7.1% (SD 0.56, 95% CI 0.55-0.58) for overweight in the fully-adjusted multinomial model. In country-specific models, the neighborhood variation in BMI ranged from 0.4 SD in Central African Republic to 2.7 SD in Sierra Leone in fully-adjusted models. Our results demonstrate a considerable range in neighborhood variation in BMI. In countries with greater neighborhood variation it is possible that BMI is being influenced by local conditions more than others with lesser neighborhood variation.
  Social Science [?] Medicine 04/2012; 75(2):311-22. · 2.70 Impact Factor
• Source

  Available from: PubMed Central

  Article: Association between socioeconomic status and self-reported diabetes in India: a cross-sectional multilevel analysis.

  Daniel J Corsi, S V Subramanian
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  ABSTRACT: To quantify the association between socioeconomic status (SES) and type 2 diabetes in India. Nationally representative cross-sectional household survey. Urban and rural areas across 29 states in India. 168 135 survey respondents aged 18-49 years (women) and 18-54 years (men). Self-reported diabetes status. Markers of SES were social caste, household wealth and education. The overall prevalence of self-reported diabetes was 1.5%; this increased to 1.9% and 2.5% for those with the highest levels of education and household wealth, respectively. In multilevel logistic regression models (adjusted for age, gender, religion, marital status and place of residence), education (OR 1.87 for higher education vs no education) and household wealth (OR 4.04 for richest quintile vs poorest) were positively related to self-reported diabetes (p<0.0001). In a fully adjusted model including all socioeconomic variables and body mass index, household wealth emerged as positive and statistically significant with an OR for self-reported diabetes of 2.58 (95% credible interval (CrI): 1.99 to 3.40) for the richest quintile of household wealth versus the poorest. Nationally in India, a one-quintile increase in household wealth was associated with an OR of 1.31 (95% CrI 1.20 to 1.42) for self-reported diabetes. This association was consistent across states with the relationship found to be positive in 97% of states (28 of 29) and statistically significant in 69% (20 of 29 states). The authors found that the highest SES groups in India appear to be at greatest risk for type 2 diabetes. This raises important policy implications for addressing the disease burdens among the poor versus those among the non-poor in the context of India, where >40% of the population is living in poverty.
  BMJ open. 01/2012; 2(4).
• Article: Environmental Profile of a Community's Health (EPOCH): An Ecometric Assessment of Measures of the Community Environment Based on Individual Perception.

  Daniel J Corsi, S V Subramanian, Martin McKee, Wei Li, Sumathi Swaminathan, Patricio Lopez-Jaramillo, Alvaro Avezum, Scott A Lear, Gilles Dagenais, Sumathy Rangarajan, Koon Teo, Salim Yusuf, Clara K Chow
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  ABSTRACT: BACKGROUND: Public health research has turned towards examining upstream, community-level determinants of cardiovascular disease risk factors. Objective measures of the environment, such as those derived from direct observation, and perception-based measures by residents have both been associated with health behaviours. However, current methods are generally limited to objective measures, often derived from administrative data, and few instruments have been evaluated for use in rural areas or in low-income countries. We evaluate the reliability of a quantitative tool designed to capture perceptions of community tobacco, nutrition, and social environments obtained from interviews with residents in communities in 5 countries. METHODOLOGY/ PRINCIPAL FINDINGS: Thirteen measures of the community environment were developed from responses to questionnaire items from 2,360 individuals residing in 84 urban and rural communities in 5 countries (China, India, Brazil, Colombia, and Canada) in the Environmental Profile of a Community's Health (EPOCH) study. Reliability and other properties of the community-level measures were assessed using multilevel models. High reliability (>0.80) was demonstrated for all community-level measures at the mean number of survey respondents per community (n = 28 respondents). Questionnaire items included in each scale were found to represent a common latent factor at the community level in multilevel factor analysis models. CONCLUSIONS/ SIGNIFICANCE: Reliable measures which represent aspects of communities potentially related to cardiovascular disease (CVD)/risk factors can be obtained using feasible sample sizes. The EPOCH instrument is suitable for use in different settings to explore upstream determinants of CVD/risk factors.
  PLoS ONE 01/2012; 7(9):e44410. · 4.09 Impact Factor
• Article: Lipid lowering on progression of mild to moderate aortic stenosis: meta-analysis of the randomized placebo-controlled clinical trials on 2344 patients.

  Koon K Teo, Daniel J Corsi, James W Tam, Jean G Dumesnil, Kwan L Chan
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  ABSTRACT: Aortic stenosis (AS) is believed to develop through an inflammatory similar to the atherosclerosis process. Based on findings from animal studies and uncontrolled clinical studies, lipid-lowering therapy with a statin is postulated to slow this process. Randomized trials, however, reported neutral results. This meta-analysis of randomized lipid trials on patients with AS examined the effects of treatment on AS progression and clinical outcomes. Echocardiographic measures of AS (aortic valve jet velocity, peak and mean valve gradients, and aortic valve area) were pooled and clinical outcomes were evaluated in 4 randomized placebo controlled trials (N=2344). Although active treatment with statin therapy was associated with highly significant 50% reduction in low-density lipoprotein cholesterol levels, there were no statistical differences between active and placebo groups in any of the echocardiographic indicators of AS severity: annual increase in AS velocity was 0.16±0.28 m/sec, and mean gradient was 2.8±3.0 mm Hg. Each trial reported no differences in clinical outcomes between the 2 treatment groups. Substantial events rates (6.6% aortic valve surgery and 1.2% cardiovascular deaths per year in SEAS with follow-up of 4.4 years and 5.8% aortic valve surgery and 0.7% cardiovascular deaths per year in ASTRONOMER over 3.5 years) were observed in these patients despite the relatively mild disease. The current data do not support the hypothesis that statin therapy reduces AS progression. Patients with mild to moderate AS may require closer follow-up because despite the less severe disease in these trials, event rates remain substantial.
  The Canadian journal of cardiology 07/2011; 27(6):800-8. · 3.36 Impact Factor
• Article: Commentary: Measuring nutritional status of children.

  Daniel J Corsi, Malavika A Subramanyam, S V Subramanian
  International Journal of Epidemiology 06/2011; 40(4):1030-6. · 6.41 Impact Factor
• Article: Can India achieve a balance of sexes at birth?

  S V Subramanian, Daniel J Corsi
  The Lancet 06/2011; 377(9781):1893-4. · 38.28 Impact Factor
• Article: Socioeconomic and geographic patterning of under- and overnutrition among women in Bangladesh.

  Daniel J Corsi, Hmwe H Kyu, S V Subramanian
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  ABSTRACT: In Bangladesh, the prevalence of overweight among adults is increasing while underweight continues to be common. However, little is known about the pattern of underweight and overweight within Bangladesh and at the neighborhood level. The objective of this study was to assess the socioeconomic and geographic patterning of underweight and overweight in the population and determine if the burdens of these nutritional disorders coexist within neighborhoods in Bangladesh. A nationally representative sample of 10,589 ever-married women aged 15-49 y from 361 neighborhoods in Bangladesh was drawn from the 2004 Bangladesh Demographic and Health Survey. BMI (in kg/m(2)) was used to model nutritional status in a multinomial regression model with women classified as underweight (<18.5 kg/m(2)), overweight (≥25 kg/m(2)), or normal (18.5-24.9 kg/m(2)). Indicators of socioeconomic status and geography included household wealth, neighborhood wealth, and place of residence. Household wealth was related negatively to underweight (OR = 0.35 [95% credible interval (int) = 0.28-0.43] for the richest one-fifth vs. the poorest one-fifth) and positively to overweight [OR = 4.36 (95% int = 2.94-6.57) for the richest one-fifth vs. the poorest one-fifth] in a graded fashion. Neighborhood wealth was positively associated with overweight [OR = 1.75 (95% int = 1.25-2.44) for the top one-third vs. the lowest one-third] and negatively associated with underweight [OR = 0.81 (95% int = 0.69-0.96) for the top one-third vs. the lowest one-third]. Residence in rural neighborhoods was significantly associated with decreased levels of overweight [OR = 0.71 (95% int = 0.58-0.91)]. We observed an inverse relationship between the random effects associated with underweight and overweight at the neighborhood level (r = -0.66; P = 0.008). In conclusion, our results suggest burdens of underweight and overweight in Bangladesh are strongly related to individual socioeconomic position but geographically distinct. Neighborhoods where women were at a higher risk of being underweight were more likely to be those where women were at a lower risk of being overweight.
  Journal of Nutrition 02/2011; 141(4):631-8. · 3.92 Impact Factor
• Article: Shared environments: a multilevel analysis of community context and child nutritional status in Bangladesh.

  Daniel J Corsi, Clara K Chow, Scott A Lear, M Omar Rahman, S V Subramanian, Koon K Teo
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  ABSTRACT: The goal of the present study was to examine the influence of community environment on the nutritional status (weight-for-age and height-for-age) of children (aged 0-59 months) in Bangladesh. In addition, we tested the association between specific characteristics of community environments and child nutritional status. Cross-sectional survey. The data are from the nationally representative 2004 Bangladesh Demographic and Health Survey. Respondents were ever-married women (aged 15-49 years) and their children (n 5731), residing in 361 communities. Child nutritional outcomes are physical measurements of weight-for-age and height-for-age in sd units. We considered the following attributes of community environments potentially related to child nutrition: (i) community water and sanitation infrastructure; (ii) availability of community health and education services; (iii) community employment and social participation; and (iv) education level of the community. Multilevel regression analysis showed that the spatial distribution of maternal and child covariates did not entirely explain the between-community variation in child nutritional status. The education level of the community emerged as the strongest community-level predictor of child height-for-age (highest v. lowest tertile, β = 0.18 (SE 0.07)) and weight-for-age (highest v. lowest tertile, β = 0.21 (SE 0.06)). In the height-for-age model, community employment and social participation also emerged as being statistically significant (highest v. lowest tertile, β = 0.13 (SE = 0.06)). The community environment influences child nutrition in Bangladesh, and maternal- and child-level covariates may fail to capture the entire influence of communities. Interventions to reduce child undernutrition in developing countries should take into consideration the wider community context.
  Public Health Nutrition 02/2011; 14(6):951-9. · 2.17 Impact Factor
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  Available from: Jocelyn Finlay

  Article: Global burden of double malnutrition: has anyone seen it?

  Daniel J Corsi, Jocelyn E Finlay, S V Subramanian
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  ABSTRACT: Low- to middle-income countries (LMICs) are believed to be characterized by the coexistence of underweight and overweight. It has also been posited that such coexistence is appearing among the low socioeconomic status (SES) groups. We conducted a cross-sectional analysis of nationally representative samples of 451,321 women aged 20-49 years drawn from 57 Demographic and Health Surveys conducted between 1994 and 2008. Body Mass Index (BMI in kg/m²), was used to define underweight and overweight following conventional cut-points. Covariates included age, household wealth, education, and residence. We estimated multinomial multilevel models to assess the extent to which underweight (BMI<18.5 kg/m²) and overweight (BM I≥ 25.0 kg/m²) correlate at the country-level, and at the neighborhood-level within each country. In age-adjusted models, there was a strong negative correlation between likelihood of being underweight and overweight at country- (r = -0.79, p<0.001), and at the neighborhood-level within countries (r = -0.51, P<0.001). Negative correlations ranging from -0.11 to -0.90 were observed in 46 of the 57 countries at the neighborhood-level and 29/57 were statistically significant (p ≤ 0.05). Similar negative correlations were observed in analyses restricted to low SES groups. Finally, the negative correlations across countries, and within-countries, appeared to be stable over time in a sub-set of 36 countries. The explicitly negative correlations between prevalence of underweight and overweight at the country-level and at neighborhood-level suggest that the hypothesized coexistence of underweight and overweight has not yet occurred in a substantial manner in a majority of LMICs.
  PLoS ONE 01/2011; 6(9):e25120. · 4.09 Impact Factor
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  Available from: Clara K Chow

  Article: Environmental Profile of a Community's Health (EPOCH): an instrument to measure environmental determinants of cardiovascular health in five countries.

  Clara K Chow, Karen Lock, Manisha Madhavan, Daniel J Corsi, Anna B Gilmore, S V Subramanian, Wei Li, Sumathi Swaminathan, Patricio Lopez-Jaramillo, Alvaro Avezum, Scott A Lear, Gilles Dagenais, Koon Teo, Martin McKee, Salim Yusuf
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  ABSTRACT: BACKGROUND: The environment in which people live is known to be important in influencing diet, physical activity, smoking, psychosocial and other risk factors for cardiovascular (CV) disease. However no instrument exists that evaluates communities for these multiple environmental factors and is suitable for use across different communities, regions and countries. This report describes the design and reliability of an instrument to measure environmental determinants of CV risk factors. METHOD/PRINCIPAL FINDINGS: THE ENVIRONMENTAL PROFILE OF COMMUNITY HEALTH (EPOCH) INSTRUMENT COMPRISES TWO PARTS: (I) an assessment of the physical environment, and (II) an interviewer-administered questionnaire to collect residents' perceptions of their community. We examined the inter-rater reliability amongst 3 observers from each region of the direct observation component of the instrument (EPOCH I) in 93 rural and urban communities in 5 countries (Canada, Colombia, Brazil, China and India). Data collection using the EPOCH instrument was feasible in all communities. Reliability of the instrument was excellent (Intraclass Correlation Coefficient--ICC>0.75) for 24 of 38 items and fair to good (ICC 0.4-0.75) for 14 of 38 items. CONCLUSION: This report shows data collection with the EPOCH instrument is feasible and direct observation of community measures reliable. The EPOCH instrument will enable further research on environmental determinants of health for population studies from a broad range of settings.
  PLoS ONE 01/2010; 5(12):e14294. · 4.09 Impact Factor
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  Available from: PubMed Central

  Article: Gender inequity and age-appropriate immunization coverage in India from 1992 to 2006.

  Daniel J Corsi, Diego G Bassani, Rajesh Kumar, Shally Awasthi, Raju Jotkar, Navkiran Kaur, Prabhat Jha
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  ABSTRACT: A variety of studies have considered the affects of India's son preference on gender differences in child mortality, sex ratio at birth, and access to health services. Less research has focused on the affects of son preference on gender inequities in immunization coverage and how this may have varied with time, and across regions and with sibling compositions. We present a systematic examination of trends in immunization coverage in India, with a focus on inequities in coverage by gender, birth order, year of birth, and state. We analyzed data from three consecutive rounds of the Indian National Family Health Survey undertaken between 1992 and 2006. All children below five years of age with complete immunization histories were included in the analysis. Age-appropriate immunization coverage was determined for the following antigens: bacille Calmette-Guérin (BCG), oral polio (OPV), diphtheria, pertussis (whooping cough) and tetanus (DPT), and measles. Immunization coverage in India has increased since the early 1990s, but complete, age-appropriate coverage is still under 50% nationally. Girls were found to have significantly lower immunization coverage (p<0.001) than boys for BCG, DPT, and measles across all three surveys. By contrast, improved coverage of OPV suggests a narrowing of the gender differences in recent years. Girls with a surviving older sister were less likely to be immunized compared to boys, and a large proportion of all children were found to be immunized considerably later than recommended. Gender inequities in immunization coverage are prevalent in India. The low immunization coverage, the late immunization trends and the gender differences in coverage identified in our study suggest that risks of child mortality, especially for girls at higher birth orders, need to be addressed both socially and programmatically. ABSTRACT IN HINDI : See the full article online for a translation of this abstract in Hindi.
  BMC International Health and Human Rights 01/2009; 9 Suppl 1:S3. · 1.44 Impact Factor