Introduction: Cerebrovascular disease (CVD) is the third cause of death and second cause of disability and dementia in adults aged ≥65 years worldwide. The few epidemiological studies of stroke in Latin America generally report lower prevalence and different patterns than developed countries.

Objective: Estimate the prevalence of stroke and associated risk factors in adults aged ≥65 years in Havana City and Matanzas provinces, Cuba.

Methods: Single phase, cross-sectional, door-to-door study of 3015 adults aged ≥65 years in selected municipalities of Havana City and Matanzas provinces. Variables studied were age, sex, educational level, and self-report and description of chronic disease (stroke, heart attack, angina, and diabetes mellitus), substance use (alcohol, tobacco), and dietary habits. Respondents were given a structured physical and neurological exam, and blood pressure was measured. Laboratory tests comprised complete blood count, fasting glucose, total cholesterol and fractions, triglycerides, and apolipoprotein E (APOE) genotype. Diagnosis of stroke was based on the World Health Organization’s definition. Stroke prevalence ratios (crude and adjusted), with 95% confidence intervals (CI), were calculated for the variables studied using a Poisson regression model. Risk association was analyzed using multiple logistic regression for dichotomous responses.

Results: Assessments were made of 2944 older adults (97.6% response rate). Prevalence of stroke was 7.8% (95% CI 6.9–8.8), and was higher in men. The risk profile for this population group included history of hypertension (OR 2.8; 95% CI 2.0–4.0), low HDL cholesterol (OR 2.6; 95% CI 1.7–3.9), male sex (OR 1.7; 95% CI 1.2–2.5), anemia (OR 1.6; 95% CI 1.1–2.5), history of ischemic heart disease (OR 1.5; 95% CI 1.0–2.3), carrier of one or two apolipoprotein E4 genotype (APOE ε4) alleles (OR 1.4; 95% CI 1.0–2.0), and advanced age (OR 1.3; 95% CI 1.1–1.9).

Conclusions: Stroke prevalence in this study is similar to that reported for Europe and North America, and higher than that observed in other Latin American countries. The risk profile identified includes classic risk factors plus anemia and APOE ε4 genotype.

Keywords: Apolipoprotein E4, population-based study, epidemiology, risk factors, stroke, prevalence, Cuba

INTRODUCTION: Estimating childhood cancer incidence globally is hampered by lack of reliable data and uniform age limits for classifying and analyzing data reported. In Cuba, cancer data has been systematically gathered and processed by the National Cancer Registry (NCR) since 1964. The International Classification of Childhood Cancer (ICCC) is currently recommended for registering neoplasms in the population aged ≤19 years. Cancer incidence data published by the Cuban Ministry of Public Health, however, uses ICCC diagnostic groups for the population aged <15 years, and topographic sites for the population aged ≥15 years.

OBJECTIVE: The objectives of this study are to describe cancer incidence in the Cuban population aged ≤19 years in 2001–2003 using the ICCC, as well as geographic distribution of incidence by sex and by principal diagnostic groups.

METHODS: A descriptive study of cancer incidence in the population aged ≤19 years was conducted using NCR data for 2001–2003. ICCC diagnostic groups and subgroups were used, and 5 age groups (<1, 1–4, 5–9, 10–14 and 15–19 years) were analyzed. Total incidence and percentages for each diagnostic group were calculated. Number of cases in each diagnostic group and subgroup was also recorded by age group, and age-specific rates per 100,000 population aged ≤19 years (ASR) and age-adjusted rates to the standard world population aged ≤19 years (AAR) were calculated. AARs for leukemias, lymphomas and central nervous system (CNS) tumors were used to analyze childhood cancer risk by sex and geographical distribution in the country’s 14 provinces and Isle of Youth Special Municipality.

RESULTS: In 2001–2003, the NCR reported 1285 new cancer cases in the population aged ≤19 years for an overall incidence of 13.9 per 100,000 population aged ≤19 years (AAR). Highest risk was found in children aged <1 year with an ASR of 21.9 per 100,000 population aged ≤19 years. Leukemias, lymphomas and central nervous system tumors comprised 61.1% of new cases, and geographic distribution of these diagnostic groups varied by sex. Childhood cancer risk was highest for males in Ciego de Avila, Villa Clara and the Isle of Youth Special Municipality and highest for females in Sancti Spíritus, Villa Clara and Cienfuegos.

CONCLUSIONS: Incidence of childhood cancer in Cuba conforms to rates reported internationally and to the incidence pattern most common in Latin America. Further research is recommended to examine risk factors influencing geographical variations in incidence within Cuba.

Keywords Pediatrics, cancer, incidence, risk, registries, epidemiology

Introduction Cancer has been the second cause of death in Cuba since 1958. The National Cancer Registry (NCR) and the National Statistics Division of the Ministry of Public Health provide incidence, mortality and other relevant epidemiological data on the disease, as a basis for analysis and decision-making in public health planning for cancer control.

Objectives Describe trends in incidence and mortality of cancer in Cuba overall and by sex since 1990, and analyze the most current 3-year data for frequent types and risk of developing and dying from cancer, by age group, sex, site, and province.

Methods Cancer incidence and mortality were described using age-adjusted rates based on standard world population for 1990–2003 and 1990–2007, respectively. Crude and age-adjusted rates were calculated for the most common sites (excluding nonmelanoma skin cancer) by sex using the latest 3-year incidence data available (2001–2003) from the National Cancer Registry and mortality data (2005–2007) from the National Statistics Division of the Ministry of Public Health. To compare risk of developing and dying from cancer among Cuban provinces, age-adjusted rates were distributed in quartiles.

Results Cancer incidence and mortality have increased in both sexes since 1990. In 2001–2003, an average of 23,710 new cancer cases were diagnosed annually (excluding nonmelanoma skin cancer), and the average annual risk of developing cancer was 216.5 per 100,000 population for men and 204.0 per 100,000 population for women. Between 2005 and 2007, there were 19,671 average annual deaths from cancer in Cuba. The risk of developing and dying from cancer varies by age group and by geographic location but was highest in Havana City province. The sites with highest incidence and mortality were lung, female breast, prostate, colon, and uterine cervix.

Conclusions Cancer incidence and mortality are increasing in Cuba, and the differences by site, age, sex and geographical distribution analyzed in this article, as well as recommended further research, should serve to inform adoption and implementation of more effective strategies for the Ministry of Public Health’s national Comprehensive Cancer Control Program.

Keywords: Cancer, epidemiology, incidence, mortality, death rate, age distribution, sex distribution, registries, Cuba

Introduction Asthma affects some 300 million people worldwide and causes over 250,000 deaths each year. It is considered a global health problem due to associated high morbidity and mortality rates; disability in inadequately treated patients; years of potential life lost (YPLL); social costs; and impact on the lives of patients, their families and society. Environmental factors, including climatic conditions, are triggers. The 2004 Cuban National Survey on Asthma found a national prevalence of 13% (CI 9.3-16.8).
Objective Describe the relationship between climatic factors andasthma mortality in Cuba from 1989 to 2003.

Methods Data on deaths from asthma in Cuba were obtained frommedical death certificates. Crude and adjusted mortality rates werecalculated using the 1981 Cuban population as the standard population;the two-parameter exponential smoothing method was used fortrend and prediction analyses, with 95% confidence intervals (CI) forestimating mortality rates by age, sex and YPLL. ArcView softwareversion 3.3 was used to obtain, adjust, and represent models of meteorologicalvariables, and a bioclimatic atlas was included.

Results Asthma mortality rates increased in Cuba in the early 90sand then decreased and stabilized in recent years; a rate of 2 per100,000 population was predicted for 2008. For the period understudy, 61% of asthma-related deaths occurred in Cuba’s dry wintermonths (November-April). The meteorological variables related to riskof asthma mortality were: atmospheric pressure (997.7-1024.3 hPa),temperature (21.3-24.3oC), number of rainy days in the dry season(15.5-45.2 days), and cloudiness (2.99-5.51%). The provinces withthe highest risk of asthma mortality were: Havana City, Havana, Ciegode Ávila, and Camagüey.

Conclusions In Cuba, unfavorable weather conditions in some geographicareas can cause the death of asthmatic patients, althoughthese are not the only factors determining asthma mortality. Theasthma mortality rate is not alarmingly high and is expected to remainstable. Nevertheless, preventive measures must be maintained,particularly for women, who suffer excess mortality from the disease.Implementation of prevention strategies that take into considerationthe seasonal nature of asthma mortality is recommended.

Keywords Epidemiology, asthma, mortality, climate, asthma in women, respiratory tract diseases, bronchial diseases

Introduction One of the most sensitive disabilities in human beings is intellectual disability. In April, 2003, a 10-month study was completed of all persons in Cuba with mental retardation (MR), producing results that included epidemiological variables on a national scale.

Objective Through follow-up research, this paper describes and analyzes 4 prenatal factors associated with MR: Down syndrome (DS), fragile X syndrome (FXS), consanguinity, and maternal alcohol use during pregnancy, in order to provide recommendations for health system decision-makers on consolidating prevention strategies at the community level and improving individual attention to persons with MR.

Materials & Methods All studies were carried out on the basis of strict ethical principles. Data for the 4 prenatal factors was gleaned from the national study’s database. Additional data on affected individuals was obtained through home visits. A previously developed screening instrument was used for clinical genetic analysis to classify possible MR causal factors as prenatal, perinatal, postnatal, psychosis, and unclassifiable. Prenatal included causal factors such as: genetic (by clinical genetic examination, metabolic screening in urine, and routine karyotypes); nonspecific (evidence of prenatal causal factor without diagnosis of genetic or environmental etiology); and environmental (prenatal medical history of biological, physical, or chemical teratogens, endocrine-metabolic diseases, or other maternal diseases known to affect fetal neurodevelopment). Frequency, prevalence, and percentages were reported using a descriptive statistical method. Impact of interventions and actions over time were also compared.

Results MR prevalence in Cuba is 1.25%, lower than the value of 2%-3% reported in developed countries. National prevalence of DS was found to be 4.3 per 10,000 population, representing 22.1% of persons with MR attributed to an ascertained genetic cause. FXS prevalence in a population of individuals of both sexes with MR, initially classified as nonspecific prenatal, psychosis, and unclassifiable, was 2.5 per 1,000 of that population; however, in males of the same population, prevalence was 3.7 per 1,000. At this first stage, such results indicate that this syndrome contributes biologically to the 1.46:1 male/female ratio among the 140,489 individuals with MR. Maternal alcohol use during pregnancy was found in 4.22% of persons with MR and consanguinity was present in 6.89% of the population with MR (10.9% of persons with mild prenatal MR and 14.2% with severe MR). This national data is subdivided by regions and provinces in this paper.

Conclusions Prevalence of MR in Cuba is lower than reference values for developed countries. Knowledge generated by this study about 4 specific causes of MR constitutes pioneering research in the Cuban context, contributing to the field of medical genetics. The results offer the basis for formulation of new scientific contributions related to MR genetics as well as preventive approaches to such genetic factors as consanguinity and to environmental factors such as maternal alcohol use during pregnancy, which affect or target embryo-fetal development of the nervous system.

Keywords Epidemiology; Mental retardation; Down syndrome; Fragile X syndrome; Consanguinity; Maternal alcohol use; Immunohistochemical test; Molecular genetics; Cytogenetics; Genetic (Abstract)