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Blood pressure pattern in urban and rural areas in Isfahan, Iran.

Hypertension is a serious public health problem in many societies due to its high prevalence and the associated increases in the risks of cardiovascular and renal disease. Some epidemiologic surveys on hypertension in eastern Mediterranean countries have reported prevalence rates among adults of up to 30%, in urban areas. To investigate the effects of an urban vs a rural environment on blood pressure (BP), this population-based survey was carried out in the city of Isfahan and its surrounding villages in Iran. The study sample comprised 8639 men and women aged 19-70 years obtained by random cluster sampling. A questionnaire was completed and BP was measured three times for each individual by trained medical interns using standard methods. Results show significant differences between mean systolic and diastolic BP and the prevalence of hypertension among urban and rural populations (P < 0.001). BP increased significantly with increasing age in both populations (P < 0.001). Total prevalence of hypertension (BP > or =160/95 mmHg or using antihypertensive drugs) was 21% for urban populations and 7% for rural ones. Urban women had higher and rural women had a lower prevalence of hypertension compared to urban and rural men, respectively (P < 0.001). Diabetes and hypercholesterolemia were more prevalent among urban people (P < 0.001) but no significant difference in relation to smoking among the two populations was found (P > 0.05). Although these differences were not adjusted for body mass index (BMI), dietary habits and other factors, it seems that environmental factors are important determinants of BP, so a change in lifestyle may be effective in lowering BP among urban people.

Adult↗

Exclusive breast-feeding is rarely practised in rural and urban Morogoro, Tanzania.

OBJECTIVE: To investigate and compare feeding practices among infants of less than 7 months of age in a rural and an urban area in Tanzania. DESIGN: Cross-sectional, questionnaire-based interview of mothers and focus group discussions with extension workers and community leaders. SETTING: Eleven villages in a rural district and 10 wards in an urban district in the Morogoro region, Tanzania, west of Dar es Salaam. SUBJECTS: Probability samples of mothers with infants of less than 7 months of age from each area). RESULTS: Exclusive breast-feeding was rarely practised in either the rural or urban areas investigated. However, the urban mothers initiated breast-feeding earlier, discarded colostrum less frequently, breast-fed exclusively for a longer period, gave breast milk as the first feed more often and delayed the introduction of solid foods for longer than their rural counterparts. The rural mothers, on the other hand, breast-fed their previous infants slightly longer than the urban mothers. CONCLUSIONS: The better performance of urban mothers could be partly due to sustained breast-feeding support in hospital settings and other campaigns which may not have reached the rural areas. In both the rural and urban areas more efforts are needed to encourage exclusive breast-feeding, to avoid premature complementation and, in the case of the urban areas, to protect extended breast-feeding.

Adult↗

Does living in an urban environment confer advantages for childhood nutritional status? Analysis of disparities in nutritional status by wealth and residence in Angola, Central African Republic and Senegal.

OBJECTIVE: The purpose of this paper is to examine the relationship between childhood undernutrition and poverty in urban and rural areas. DESIGN: Anthropometric and socio-economic data from Multiple Indicator Cluster Surveys in Angola-Secured Territory (Angola ST), Central African Republic and Senegal were used in this analysis. The population considered in this study is children 0-59 months, whose records include complete anthropometric data on height, weight, age, gender, socio-economic level and urban or rural area of residence. In addition to simple urban/rural comparisons, the population was stratified using a wealth index based on living conditions and asset ownership to compare the prevalence, mean Z-score and odds ratios for stunting and wasting. RESULTS: In all cases, when using a simple urban/rural comparison, the prevalence of stunting was significantly higher in rural areas. However, when the urban and rural populations were stratified using a measure of wealth, the differences in prevalence of stunting and underweight in urban and rural areas of Angola ST, Central African Republic and Senegal disappeared. Poor children in these urban areas were just as likely to be stunted or underweight as poor children living in rural areas. The odds ratio of stunting in the poorest compared with the richest quintile was 3.4, 3.2 and 1.5 in Angola ST, Senegal and Central African Republic, respectively. CONCLUSIONS: This paper demonstrates that simple urban/rural comparisons mask wide disparities in subgroups according to wealth. There is a strong relationship between poverty and chronic undernutrition in both urban and rural areas; this relationship does not change simply by living in an urban environment. However, urban and rural living conditions and lifestyles differ, and it is important to consider these differences when designing programmes and policies to address undernutrition.

Angola↗

Urban-rural differences in the growth of South African black children.

Urbanization is a major migratory process characteristic of developing countries. The majority of comparisons of the growth of urban and rural children from developed countries reflect greater heights and weights, and by implication health, of urban children. Urban-rural comparisons of South African black children are few in number and have concentrated on 'average' children, thereby omitting the factor of socioeconomic status. The present study compares two groups of urban children of high (n = 307) and average (n = 867) socioeconomic status and two groups of rural children. The rural children came from farm labourer's families (n = 392) and traditional subsistence farming environments (n = 420). The children ranged in age from 5 to 19 years. In general the well-off urban children were consistently, but not significantly, larger than all other groups and 'average' urban children were consistently and at times significantly smaller and lighter. The growth of the two rural groups fell between these extremes but were also consistently different in that the children of farm labourers were significantly lighter at all ages than children living in a traditional subsistence economy. It is concluded that the average urban environment in South Africa is not conducive to improved growth and health unless it is accompanied by an improved socioeconomic status.

Adolescent↗

The prevalence of hypertension in rural and urban Cameroon.

BACKGROUND: The quickening pace of change and adoption of western lifestyles by people in developing countries has led to a sharp rise in the incidence of hypertension. Yet epidemiological studies using validated methods are rare especially in Central Africa. METHODS: The prevalence of hypertension, according to the World Health Organization definition (systolic blood pressure [SBP] > or = 160, diastolic [DBP] > or = 95 mmHg), was estimated by a population-based survey in 1798 Cameroonian subjects aged 25-74 years. There were 746 individuals from a rural area (308 men, 438 women) and 1052 (461 men, 591 women) from an urban area. RESULTS: The response rate was 95% and 91% for the rural and urban populations respectively. The age-standardized prevalence of hypertension was significantly higher in the urban than in the rural area. It was 16.4% (95% CI: 11.6-21.2) in urban men and 12.1% (95% CI: 7.9-16.2) in urban women, while it was 5.4% (95% CI: 2.9-8.0) in rural men and 5.9% (95% CI: 3.8-8.0) in women. Borderline hypertension (SBP 140-160, DBP 90-95 mmHg) was detected in 7.4% (95% CI: 4.4-10.4) and 6.6% (3.1-10.2) of urban, and 7.3% (95% CI: 4.7-9.9) and 2.9% (95% CI: 1.5-4.4) of rural men and women respectively. CONCLUSIONS: These results indicate that hypertension is still uncommon in rural Cameroon but occurs frequently in the urban community, reaching a proportion comparable with industrialized urban communities.

Adult↗

Urban-rural differences in coronary heart disease in a low incidence area. The Puerto Rico heart study.

This report explores coronary heart disease (CHD) risk factors and the incidence of new CHD events developing over a two and one-half year period in 8793 urban and rural Puerto Rican men aged 45--64 years. Rural men had a lower average blood pressure, serum cholesterol, blood sugar, heart rate and relative weight than urban men. They were more active physically and although more of them smoked, they smoked fewer cigarettes than urban dwellers. The age-adjusted CHD incidence rate for urban men was 1.5 times that of rural men. Among rural areas the most rural had the lowest incidence. Among urban areas there was a suggestive trend of increasing incidence with degree of urbanization. Differences in conventional risk factors, while substantial, do not entirely explain the modest differences in incidence. There also appeared to be a relation with geographic mobility. Urban men who had always lived in the same area had an incidence rate as low as that for rural men whereas recent rural migrants to urban areas had the highest rates of all.

Adult↗

Urban-rural patterns of increasing antidepressant use among nursing facility residents.

OBJECTIVE: To characterize changing patterns of antidepressant use in nursing facilities across the urban-rural continuum during the mid-1990s. DESIGN: Retrospective analysis of antidepressant drug codes and demographic/clinical data from the Minimum Data Set (MDS) 1994 to 1997. SETTING: Kansas nursing facilities. PARTICIPANTS: Facility residents aged 65 and older. MEASUREMENTS: We examined (1) admission use and (2) after-admission use for newer and older antidepressants for each year separately, using a 4-stratum system to classify nursing facility location by county, from urban to most rural. Incidence rate ratios were determined for antidepressant use in each stratum using the urban strata as the reference. RESULTS: Remarkable increases in use of newer antidepressants were seen over time in all strata, but use was highest in the urban area. Modest urban-rural gradient effects attenuated over time and were not consistently seen across analyses and years. Tricyclic antidepressant (TCA) use remained largely unchanged over time and at much lower rates than newer agents. However, TCA use was also modestly higher in urban areas. Differences were clearer for use after admission, in contrast with admission use patterns. CONCLUSIONS: Newer antidepressants were rapidly adopted across the urban-rural continuum from 1994 to 1997. Marked increases in both admission and after-admission use of newer antidepressants were seen. Both newer and older antidepressants were used at modestly higher rates in urban areas. Further work is needed to elucidate the patient, prescriber, and facility factors that explain these prescribing patterns.

Aged↗

Correlates of late-life major depression: a comparison of urban and rural primary care patients.

OBJECTIVE: The objective of this study was to determine whether factors associated with depression differ between elderly residents of rural and urban areas. METHODS: The research design was cross-sectional and observational. The study subjects consisted of 926 Medicare primary care patients (650 urban and 276 rural) who were age 65+ and cognitively intact and had enrolled in a randomized, controlled Medicare demonstration. Major depression was identified by the Mini International Neuropsychiatric Interview. A logistic regression model was estimated that included a rural-urban indicator variable, additional independent variables, and interaction terms between the rural-urban indicator and independent variables that were significant at p <0.10. RESULTS: A total of 8.3% of the rural and 14.8% of the urban patients were identified as having major depression. Reporting 0-1 close friends (odds ratio [OR]: 6.86; 95% confidence interval [CI]: 2.18-21.58), 2+ emergency room visits during the past 6 months (OR: 4.00; 95% CI: 1.19-13.43), and more financial strain (OR: 1.50; 95% CI: 1.01-2.23) were associated with significantly higher likelihood of major depression among rural as compared with urban patients. The SF-36 Physical Component Summary score had a curvilinear relationship with major depression and was higher for urban patients. The predicted probability for major depression is lower for the rural patients when financial strain is low, about the same for rural and urban patients when strain is intermediate, and higher for rural patients when strain is high. CONCLUSIONS: Clinicians in rural areas should be vigilant for major depression among patients with very few close friends, several recent emergency department visits, and financial strain.

Aged↗

Differences in the timing of reproduction between urban and forest European blackbirds (Turdus merula): result of phenotypic flexibility or genetic differences?

Species which have settled in urban environments are exposed to different conditions from their wild conspecifics. A previous comparative study of an urban and a forest-living European blackbird population had revealed a three weeks earlier onset of gonadal growth in urban individuals. These physiological adjustments are either the result of genetic differences that have evolved during the urbanization process, or of phenotypic flexibility resulting from the bird's exposure to the different environmental conditions of town or forest. To identify which of these two mechanisms causes the differences in reproductive timing, hand-reared birds originating from the urban and the forest populations were kept in identical conditions. The substantial differences in the timing of reproduction between urban and forest birds known from the field did not persist under laboratory conditions, indicating that temporal differences in reproductive timing between these two populations are mainly a result of phenotypic flexibility. Nevertheless, urban males initiated plasma luteinizing hormone (LH) secretion and testicular development earlier than forest males in their first reproductive season. Moreover, plasma LH concentration and follicle size declined earlier in urban females than in forest females, suggesting that genetic differences are also involved and might contribute to the variations in the timing of reproduction in the wild.

Animals↗

Type 2 diabetes in rural and urban population: diverse prevalence and associated risk factors in Bangladesh.

AIMS: To describe differences in prevalence of Type 2 diabetes mellitus with its associated risk factors between rural and urban populations in Bangladesh. Diagnostic criteria [fasting blood glucose (FBG) and oral glucose tolerance tests (OGTT)] were compared and reviewed for both populations. METHODS: A total of 1555 subjects from urban and 4757 from rural communities (age > or = 20 years) with similar cultural and ethnic backgrounds were randomly selected in a cross-sectional survey. FBG values were determined from all and 2-h post-glucose capillary blood samples were determined after a 75-g oral glucose load for a selected number (urban 476, rural 1046). RESULTS: A higher prevalence of diabetes was found in urban (8.1%) compared with rural populations (2.3%). Age, sex and waist-to-hip ratio for men were significant risk factors for both urban and rural subjects following fasting and 2-h post-glucose values adjusted for a number of confounding variables. Poor agreement was observed between FBG and OGTT for both urban (kappa 0.41) and rural (kappa 0.40) areas. CONCLUSIONS: A higher prevalence of diabetes mellitus (DM) in the urban population was observed compared with rural subjects despite similar body mass indexes (BMI). Differences in obesity, waist/hip ratio or hypertension failed to explain the increasing occurrence of T2DM in the urban population.

Adult↗

A secondary analysis of smoking among rural and urban youth using the MTF data set.

This paper compares rural and urban youth cigarette-smoking behavior using the Monitoring the Future data set, a national, probability-based, multi-stage sample design. Cigarette smoking was examined by region, race, and gender over time. Results indicated that rural White males smoked more often (30-day prevalence of 34%) than any other group. Urban Black males smoked the least (10%). Urban White females smoked more (30-day prevalence of 33%) than urban Black females (7%). In general, rural and urban Whites reported smoking at significantly higher rates than rural and urban Blacks. Smoking rates declined steadily for both rural and urban Black females and urban Black males over the study period. These data document distinctive patterns of tobacco use among the nation's youth, which can be used by program planners for specific targeted interventions.

Adolescent↗

Utilization of preventive medical services in the United States: a comparison between rural and urban populations.

Differences between rural and urban residents in their utilization of three clinical preventive services--Papanicolaou screening tests (Pap smears) for women aged 18 to 65, mammograms for women aged 50 to 69 and flu shots for people aged 65 or older--were examined using a nationally representative sample from the 1994 U.S. National Health Interview Survey. Eighty-two percent of urban women and 79 percent of rural women (P = 0.11) had Pap smears. Sixty-eight percent of urban women and 61 percent of rural women (P = 0.01) had mammograms. Flu shots were received by 55 percent of urban and 58 percent of rural elderly residents (P = 0.11). Of women aged 50 to 69 who had a high school education or whose annual household income was between $15,000 and $34,999, significantly fewer rural than urban women had mammograms (P < 0.01). However, the proportion of rural women receiving mammograms was not significantly different from that of urban women after adjusting for their education, household income and health insurance status. Education level, house-hold income and health insurance coverage were positively associated with utilizing mammograms. These results suggest that differences in the utilization of preventive services between rural and urban women vary by services. Improving socioeconomic status and health insurance coverage of rural women may reduce the disparity in mammogram use between rural and urban women. Mechanisms of how a woman's socioeconomic status affects her utilization of mammograms needs further study.

Adult↗

Rural-urban differences in the social climate surrounding environmental tobacco smoke: a report from the 2002 Social Climate Survey of Tobacco Control.

CONTEXT: Although previous research has found smoking rates to be higher among residents of rural areas, few studies have investigated rural-urban differences in exposure to environmental tobacco smoke (ETS). OBJECTIVE: This study contrasted the social climate surrounding ETS among Americans who resided in 5 levels of county urbanization. DESIGN: Data were collected via telephone interviews administered to a representative sample of 3,009 civilian, noninstitutionalized adults over age 18 in the United States. Households were selected using random digit dialing procedures. FINDINGS: Compared to residents of urban counties, rural residents reported fewer restrictions on smoking in the presence of children and lower incidences of smoking bans in households, family automobiles, work areas, convenience stores, fast-food restaurants, and restaurants. Interestingly, when rural-urban variations in knowledge and attitudes about ETS were examined, the magnitude of rural-urban differences was smaller or nonexistent for these indicators. Moreover, logistic regression models indicated that none of these rural-urban differences in knowledge and attitudes persisted after statistically controlling for region, smoking status, gender, race, age, and education factors. This suggests that the observed rural-urban differences in ETS bans could not be explained adequately by rural-urban differences in knowledge and attitudes about the dangers of ETS. CONCLUSIONS: The policy implications of this research point to a greater need in rural America for programs focusing on the restriction and elimination of ETS. They also suggest that programs focusing only on influencing the levels of ETS knowledge and attitudes among the general population may not be adequate in producing the desired change.

Adolescent↗

Quality of care for acute myocardial infarction in rural and urban US hospitals.

CONTEXT: Acute myocardial infarction (AMI) is a common and important cause of admission to US rural hospitals, as transport of patients with AMI to urban settings can result in unacceptable delays in care. PURPOSE: To examine the quality of care for patients with AMI in rural hospitals with differing degrees of remoteness from urban centers. METHODS: This cohort study used data from the Cooperative Cardiovascular Project (CCP), including 4,085 acute care hospitals (408 remote small rural, 893 small rural, 619 large rural, and 2,165 urban) with 135,759 direct admissions of Medicare beneficiaries ages 65 and older for a confirmed AMI between February 1994 and July 1995. Outcomes included use of aspirin, reperfusion, heparin, and intravenous nitroglycerin during hospitalization; use of beta-blockers, aspirin, and angiotensin-converting enzyme (ACE) inhibitors at discharge; avoidance of calcium channel blockers at discharge; and 30-day mortality. FINDINGS: Substantial proportions of Medicare beneficiaries in both urban and rural hospitals did not receive the recommended treatments for AMI. Medicare patients in rural hospitals were less likely than urban hospitals' patients to receive aspirin, intravenous nitroglycerin, heparin, and either thrombolytics or percutaneous transluminal coronary angioplasty. Only ACE inhibitors at discharge was used more for patients in rural hospitals than urban hospitals. Medicare patients in rural hospitals had higher adjusted 30-day post-AMI death rates from all causes than those in urban hospitals (odds ratio for large rural 1.14 [1.10 to 1.18], small rural 1.24 [1.20 to 1.29], remote small rural 1.32 [1.23 to 1.41]). CONCLUSIONS: Efforts are needed to help hospital medical staffs in both rural and urban areas develop systems to ensure that patients receive recommended treatments for AMI.

Aged↗

Caries experience of urban and rural children in Saudi Arabia.

OBJECTIVE: Caries experience and restorative treatment needs often are reported to be higher in urban than rural areas in developing countries. The purpose of this study was to compare caries experience in 12- and 13-year-old children in urban and rural areas of Saudi Arabia, a young, oil-rich, developing country. METHODS: A random sample of 1,873 schoolchildren aged 12-13 years from urban and adjoining rural areas of 10 administrative regions in the Kingdom of Saudi Arabia were examined for dental caries. Questionnaires also were administered to elicit information on the frequency of snacking as well as consumption of sweets and soft drinks. RESULTS: No statistically significant differences were found between urban and rural children in caries experience in permanent teeth (mean DMFT = 2.69 in urban areas; 2.65 in rural areas), frequency of snacking, or frequency of consumption of sweets and soft drinks. The percentage of DMFT found to be D was equally high (> 89%) in both urban and rural areas, indicating a high level of restorative treatment need. CONCLUSION: In Saudi Arabia, an economically prosperous developing country, exposure to cariogenic diet in urban and rural areas does not differ. Also, a difference in caries experience in urban and rural areas often reported for developing countries does not apply to Saudi Arabia.

Adolescent↗

Urban growth and decline: San Jose and St. Louis in the 1960's.

The population changes in San Jose and St. Louis between 1960 and 1970 exemplify the two broad trends-urban formation followed by metropolitan dispersal-that have shaped 20th-century urbanization in this country. The fact that these developmental trends were expressed through demographic processes found to be common to both cities, despite their contrasting recent experiences, suggests that generalizations can be made about the complex forces underlying urbanization. The formation of metropolitan San Jose's population parallels the traditional process whereby a region's growth comes to be focused, through migration, on a few urban centers. The modern variant is not characterized by a rural-to-urban shift, however, but by migration flows among urban areas, and particularly to a few most-favored areas, such as San Jose. Migratory growth has left a powerful demographic legacy in San Jose. This legacy is also instructive for studying the migratory formation of any new city's population. Its demographic character determines its demographic destiny, whose likely variations we can now perceive with some clarity. San Jose's population is both youthful and chronically migratory. The presence of many prospective parents and relatively few elderly persons lays a broad foundation for the population's continued growth through natural increase, despite the national downturn in fertility (14). Even without further net in-migration, the population of new cities like San Jose would continue to grow at an above-average rate. The hypermobility of San Jose's population (that is, its propensity for further migration) also has an important bearing on the future. With about 21 migrants entering and 17 departing each year per hundred residents, San Jose's rapid migratory growth rests (as it would in other new cities) on a precarious arithmetic balance. A significant dip in local employment growth could easily reduce net migration to a small fraction of its present high level. Even a slight decline would result in the inflow's no longer exceeding the high volume of outflow. Demographic analysis alone cannot foresee such an employment downturn, but if it happened, the migratory downturn probably would be swift. Hypermobility also works the other way; and given San Jose's focal position in California's expanding metropolitan structure (with its virtually endless supply of migratory growth), net migration could resume with equal swiftness. The outward dispersal of population from central cities that has occurred in St. Louis has been accelerating in other cities as well, and will remain a prominent feature of U.S. urban growth. It may seem paradoxical that in a period noted for something called "urban growth" there are so many declining central cities, but that is merely one indication that the "central city" no longer is the real city, except in name. Real city or not, the central city can expect to come into political conflict with other jurisdictions created in the process of dispersion. In cities like St. Louis, where population is dispersing but old political boundaries are fixed, the problems of the central city are separated from the resources in the suburbs. Transitional problems associated with persistent and severe outmigration also arise: accumulation of disadvantaged citizens, declining demand for city housing, and a diminished replacement capacity in the population. Carried far enough, the last of these problems results in natural decrease, and thereafter the population's decline acquires its own dynamic. As noted earlier, the white population in St. Louis has reached this point: The number of persons dying now exceeds the number being born. For two reasons, this natural decrease can do little other than intensify. First, a substantial proportion of whites are either entering or already within the high-mortality age brackets. The white population's crude death rate therefore will continue to rise. Second, prospective parents are becoming scarce among St. Louis's whites, and the national evidence that parents in general will choose to have smaller families continues to mount. The white population's crude birth rate is therefore likely to fall, barring a dramatic increase in fertility or a strong and sustained inflow of childbearing families. Nor is St. Louis's black population likely to grow substantially. It is expanding steadily through natural increase, but black migration out of the city is more than enough to cancel that increase.

Adolescent↗

Epidemiology of rheumatic diseases in rural and urban populations in Indonesia: a World Health Organisation International League Against Rheumatism COPCORD study, stage I, phase 2.

To determine the incidence of musculoskeletal pain, disabilities, and help seeking behaviour, a questionnaire was administered to a rural population of 2184 men and 2499 women and an urban population of 481 men and 590 women aged over 15 years by house to house interviews with completion rates of 95.2% (rural) and 97.1% (urban). The incidences of pain in the joints, back, or neck were 23.6% (rural) and 31.3% (urban). The incidence of disability due to an inability to walk, lift, carry, and dress was 2.8% (rural) and 0.9% (urban). The percentage of the population with pain who had to stop work owing to disability was 75% (rural) and 78% (urban). Official health care facilities were used by 62% (rural) and 71% (urban) of the population. Traditional health care was used by 87% (rural) and 89% (urban). The high percentage of subjects unable to work was due to a predominance of manual labour occupations (rural, 90%, urban, 80%). The age and sex specific incidence of rheumatic diseases in these populations were similar to other developing and developed countries. The primary rheumatology service was inadequate due to the low priority given by the health service to non-communicable diseases and inadequate rheumatology teaching of the primary health care doctors during undergraduate training. Musculoskeletal pain is a major public health problem in Indonesia and is still not fully appreciated.

Adolescent↗

Urbanization elicits a more atherogenic lipoprotein profile in carriers of the apolipoprotein A-IV-2 allele than in A-IV-1 homozygotes.

Coronary heart disease (CHD) is increasing in developing countries, particularly in urban areas. The impact of urbanization and apolipoprotein (apo) A-IV genetic polymorphism on plasma lipoproteins was studied in 222 men and 236 women from rural and urban Costa Rica. The apoA-IV allele frequencies were 0.937 for apoA-IV-1 and 0.062 for apoA-IV-2, Significant interactions between the apoA-IV polymorphism and area of residence (rural versus urban) were detected for HDL cholesterol (P = .003), apoA-I (P = .05), LDL particle size (P = .01), and LDL/HDL cholesterol ratio (P = .005). Urban compared with rural carriers of the apoA-IV-2 allele had significantly lower plasma HDL cholesterol (0.95 versus 1.17 mmol/L) and apoA-I (980 versus 1140 mg/L), a significantly higher LDL/HDL cholesterol ratio (3.35 versus 2.39), and significantly smaller LDL particles (258 versus 263 A). In contrast, no significant rural-urban differences for these parameters were found in apoA-IV-1 homozygotes. Regardless of their apoA-IV phenotype, urban residents consumed more saturated fat (P = .02) and smoked more cigarettes per day (P = .03) than rural residents. A significant interaction between saturated fat intake and apoA-IV phenotype was found for HDL cholesterol (P < .0003) and LDL/HDL cholesterol ratio (P < .003). Increased saturated fat intake (13.6% versus 8.6% of calories) was significantly associated with 6% higher HDL cholesterol and no change (0.7%) in LDL/HDL cholesterol ratio in apoA-IV-1 homozygotes and with 19% lower HDL cholesterol and 37% higher LDL/HDL cholesterol ratio among carriers of the apoA-IV-2 allele. Smokers (> or = 1 cigarette per day) had significantly lower HDL cholesterol (P < .005) and apoA-I (P < .01) concentrations than nonsmokers (< 1 cigarette per day), particularly among carriers of the apoA-IV-2 allele (-19% and -13%) compared with apoA-IV-1 (-4% for both). After taking these lifestyle characteristics into account, the areas of residence by phenotype interactions for plasma lipoprotein concentrations were no longer statistically significant. Lifestyles associated with an urban environment, such as increased smoking and saturated fat intake, elicit a more adverse plasma lipoprotein profile among Costa Rican carriers of the apoA-IV-2 allele than in apoA-IV-1 homozygotes. Therefore, under the conditions studied, persons with the apoA-IV-2 allele may be more susceptible to CHD.

Adult↗