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218 ORIGINAL ARTICLE Smoking is the most frequent risk factor for cardiovascular diseases in Croatian Western region: findings of the Croatian health survey 2003 \ulija Malatestinić 1 , Nena Rončević 2 , Henrietta Benčević-Striehl 1 , Suzana Janković 1 , Vladimir Mićović 1 1 Teaching Institute of Public Health of Primorsko-goranska County, University School of Medicine, 2 University School of Philosophy; Rijeka, Croatia Corresponding author: \ulija Malatestinić Teaching Institute of Public Health of Primorsko-goranska County, University School of Medicine Krešimirova 52/a, 51 000 Rijeka, Croatia Phone: ++385 51 334 530 ; Fax.: ++385 51 213 948; Email: dulija.malatestinic@zzjzpgz.hr Original submission: 11 February 2009; Revised submission: 17 April 2009; Accepted: 04 May 2009. Med Glas 2009; 6(2): 218-226 ABSTRACT Aim To estimate the prevalence of selected behavioral risk factors for cardiovascular diseases in the western region of Croatia and to determine the differences based on age and gender. Methods A national survey on health status and health behavior of the adult population has been conducted. The representative sample of 10,766 households for six officially defined regions of Croatia has been determined, and Western region has been included with 1,562 inhabitants, aged 18 years and older. The overall response rate of administered face-to-face questionnaire was 85-6%. Prevalence rates per 100 inhabitants (smoking, eating habits, alcohol consumption, physical activity, socio-economic characteristics, chronic conditions) have been determined. Results Nearly half (46.3%) of the adults were smokers or had quit smoking less than 10 years ago. Prevalence of high blood pressure was high amounting to 40.6% and it was higher in middle aged males (46.7%, p
INTRODUCTION Cardiovascular diseases (CVDs) are the major cause of death in most European transitional countries (1). In Croatia CVDs are the leading cause of death and account for more than half of the overall mortality (2,3). Unfortunately, exact data on the spread of the most important risk factors, such as hypertension, smoking, obesity, hypercholesterolemia, hypertriglyceridemia, insufficient physical activity etc. were not available prior to Croatian Adult Health Survey (CAHS) in 2003. It provided timely, reliable, cross-sectional estimates, supporting the development of a public health information system, health promotion, with emphasis on CVD prevention, CVD risk reduction and healthier lifestyles promotion among the general population (4). Furthermore, there have been no systematic and comparable studies of the risk factors on a representative sample of the population at the national as well as the regional level. Although CVDs account for more than half of the overall mortality in Croatia, the support for the research in this area, during the last decade, has not been sufficient. In the period between 1991 and 2004, Croatia had the lowest CVD publication rates (in 2003 the estimated proportion was 1.2% as opposed to 7.3-11.8% in other analysed countries) in the MEDLINE database among the countries included into the analysis (5). The mortality caused by CVDs in the population can be significantly reduced by acquiring a healthier way of life such as non-smoking, proper diet and regular physical activity. It is well known that health promotion and primary prevention are of substantial importance in decreasing CVD mortality and morbidity (5). One of the main hypotheses in our research program on health status and health behavior in adult population of the Croatian Western region was a high prevalence of CVDs risk factors with gender and age differences and different hierarchy in the prevalence of selected behavioral risk factors for CVDs as compared with the national level. Malatestinićet al Smoking in the Croatian Western Region PARTICIPANTS AND METHODS Participants The data were collected in the summer of 2003, and results have been officially released in December 2003 in the cross-sectional survey entitled “Croatian Adult Health Survey” (CAHS) (6). The main goal of the survey was to examine the health status, risk factors and health care utilization with a focus on cardiovascular diseases (CVDs). Conceptually, the survey was based on existing studies such as the CINDI (7,8), and Short Form 36 of the World Health Organization (9). The development, design and implementation of the 2003 CAHS was conducted by the Canadian Society of International Health, Croatian Ministry of Health, Croatian Central Bureau of Statistics, Andrija Štampar School of Public Health and the National Institute of Public Health, Zagreb, Croatia, and the cooperation resulted in completion of a high quality population health survey that provided first comparable data at a regional level. A sample design for the 2003 CAHS covered approximately 98% of the Croatian population aged 18 and older, due to exclusion of people living in non-conventional dwellings, stationed in institutions, full-time members of the Croatian Armed Forces and residents of some remote regions. Observed regions The 2003 CAHS used the official definition of the five sub-national regions (groupings of counties) as proposed by the Central Bureau of Statistics. In order to ensure sufficient/representative sample for Zagreb (the capital), it was removed from the Central region and considered as the sixth region for the 2003 CAHS. Using the 2001 Census of Households, the six main regions were further stratified according to the city type (town/ municipality) and counties to account for population differences. Overall, as the country was stratified into 20 design strata a sample of 11,250 units was required to meet the survey objectives 219
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284 ERRATUM Quality of the cardiova
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