Burden and circulating strains of rotavirus infection in Latin America & the Caribbean: systematic review and meta-analysis

LINHARES AC; STUPKA JA; CIAPPONI, AGUSTÍN; BARDACH, ARIEL; GLUJOVSKY, D; ARUJ, PATRICIA; MAZZONI, AGUSTINA; RODRIGUEZ JAB; REARTE A; LANZIERI TM; ORTEGA-BARRIA, EDUARDO; COLINDRES, ROMULO

Conferencia; 9th International Rotavirus Symposium.; 2010

BACKGROUNDTo quantify the association between tobacco consumption, tobacco expenditures and morbi-mortality attributed to tobacco, and income level. Specifically, to compare high-income versus lower income groups in terms of smoking prevalence, quantity of tobacco consumption, disease incidence and mortality attributed to tobacco and household expenditure on tobacco as a percentage of total household expenditure.AIMWe included observational studies, published in the last 20 years, with direct assessment of IL. We searched in the main literature databases, conferences index, tobacco control agencies, and contacted experts. Two independent researchers by register screened titles and abstracts (agreement >0.9). The full text of selected studies and its risk of bias (using a STROBE-based checklist) were assessed by two researches. One reviewer extracted data, and a second one checked it. Disagreements were solved by consensus.We conducted a random effects meta-analysis based on adjusted OR using Stata 9.0. We performed pre-planned subgroup and sensitivity analysis to evaluate heterogeneity (I2>50%) by calendar decade, continent, WHO region, country standardized mortality rate, risk of bias, gender, and age.METHODSWe included observational studies, published in the last 20 years, with direct assessment of IL. We searched in the main literature databases, conferences index, tobacco control agencies, and contacted experts. Two independent researchers by register screened titles and abstracts (agreement >0.9). The full text of selected studies and its risk of bias (using a STROBE-based checklist) were assessed by two researches. One reviewer extracted data, and a second one checked it. Disagreements were solved by consensus.We conducted a random effects meta-analysis based on adjusted OR using Stata 9.0. We performed pre-planned subgroup and sensitivity analysis to evaluate heterogeneity (I2>50%) by calendar decade, continent, WHO region, country standardized mortality rate, risk of bias, gender, and age.RESULTSOut of 9575 references we finally included 137 articles (86% cross-sectional studies). A total of 125 papers (N=31,146,096 subjects) reported smoking prevalence, being higher among people with Low-IL than High-IL (OR 1.48, 95%CI 1.38-1.59) (Figure 1). This finding was consistent across all subgroups, and was marked especially after ?90, except for the Eastern Mediterranean Region (Table 1).Considering only studies with the three IL categories, a gradient was observed (for both genders): Low-IL vs. High-IL OR 1.54 (1.39-1.72), and Middle-IL vs. High-IL OR 1.25 (1.16-1.33).Twenty studies (N=987,885) reported adjusted data for all cause of death and tobacco attributable diseases (cardiovascular and coronary heart disease; pulmonary disease; and low birth weight). All studies, except three with null effect, exhibited statistically significant higher ORs of tobacco outcomes as household income decreased (Table 2).The median proportion of tobacco/total household expenditures was 10.7%, 3.7%, and 1.8% in Low-IL, Medium-IL and High-IL respectively (Table 3).CONCLUSION?    This meta-analysis confirmed and quantified an inverse relationship between income level and smoking prevalence and its consequences. It also displays data on the negative impact of tobacco consumption on household expenditures.?    These results support the vulnerability theory: tobacco inflicts a greater harm among disadvantaged groups.?    Policies and interventions focusing on smoking prevention and cessation should prioritize the poorest groups.