Working with: Dr. Stephen Hwang
Dr. Mejia-Lancheros did her undergraduate studies in Nursing Science at the Universidad Nacional de Colombia. After working as an Registered Nurse in Colombia, Italy and Spain, she received a Masters in Public Health from the Pompeu Fabra University (Barcelona, Spain), and a PhD in Public Health and Epidemiology from the Autonomous University of Barcelona (Barcelona, Spain). Cilia was also a post-doctoral research fellow at the School of Public Health, Physiotherapy and Sports Science at University College Dublin, in Ireland.
Meet Dr. Mejia-Lancheros
I looked at a cohort of more than 6,000 people over 55 years of age across Spain, and with health conditions such as diabetes, dyslipidemia, higher BMI that put them at high risk for a cardiovascular disease (CVD). I wanted to explore factors that might impact their health outcomes, and care. I explored a range of questions, including:
- The kinds of pharmacological treatment for hypertension, diabetes and dyslipidemia people with lower levels of formal education (which we used as a proxy for socioeconomic position) were receiving from health care system. We found that there was no difference between treatments prescribed for people with lower education vs. people with higher education. We attributed this to the health care system in Spain, which, at the time we collected the data, was universal for all citizens, with a strong primary care component. In addition, during the study period (2003-2010), the majority of pensioners did not pay for their prescription medicines.
- The types of circumstances that contributed CVD. I found that lower levels of formal education were associated with higher incidence of stroke, in particular in men. We did not find an association between higher incidence of any CVD and the other two factors we examined: living alone, and living with depression. Literature suggests that people with lower levels of formal education in some contexts will be dealing with a lot of stressful situations, have less access to healthy food, and fewer opportunities for exercise. In some situations you’ll also see higher levels of smoking and alcohol consumption.
To understand the results, it’s important to consider the historical context in Spain. Seventy-four per cent of the cohort had access only to a primary school education. This is particularly true for women, whose access to university education was limited until the 1970s.
It’s also important to understand the current context around social and health policy. During the study period, most of our cohort was retired. The average Spanish pension is around EUR 900 per month, which is very low.
Where we saw positives in terms of equity and treatment, we attributed this to universal access to health care, and access to prescription drugs for older people. Since we published our findings, some regions of Spain have introduced charges for some prescription drugs as mandated by the national government.
Finally, in terms of economic context, Spain was famously impacted by the economic crisis that started in 2008, and of course our cohort would have felt the negative impact of this.
I worked with the Lifeways Cross-Generation Cohort Study. We looked at three generations of people in Ireland. The Irish population experienced a series of significant historical, economic and political events over the 20th century. We wanted to look at how experiences and health outcomes ripple through through generations.
I learned that the impacts of poverty, stress, poor nutrition and smoking may be passed on through generations, through both the maternal and paternal line. The health status and experiences of grandparents might also imprint on the health of future generations.
I work with At Home/Chez Soi, a randomized controlled trial which is looking at the effects of rent supplements coupled with mobile supports for people who are dealing with both homelessness and mental health problems. We are now working with five years of data, and examining the effects of the intervention on the housing stability, quality of life, community integration, health care utilization and health outcomes of participants. We’re also looking at how the intervention impacts costs in other parts of the public sectors such as the health care and justice systems.
I’d like to see the findings used directly to improve health and well-being for all individuals at each stage of their life course. This would mean seeing findings reflected in both clinical practice and policies aimed to reduce the health inequalities and inequities within and between population groups.
Mejia-Lancheros C, Mehegan J, Murrin Celine M, Kelleher Cecily C for the Lifeways Cross- Generation Cohort Study Group. ‘Smoking habit from the paternal line and grand-child’s overweight or obesity status in early childhood. Prospective findings from the Lifeways Cross- Generation Cohort Study’. Journal: International Journal of Obesity. Ahead of print. DOI: 10.1038/s41366-018-0039-8.
Mejia-Lancheros C, Segurado R, Mehegan J, Murrin Celine M, Kelleher Cecily C for the Lifeways Cross-Generation Cohort Study Group. Parental population exposure to historical socioeconomic and political periods and grand-child’s birth weight in the Lifeways Cross- Generation Cohort Study in the Republic of Ireland. Journal: SSM-Population Health. 2018;100-116. doi: 10.1016/j.ssmph.2017.11.011.
Mejia-Lancheros Cilia, Mehegan John, Viljoen Karien, Murrin Celine, Kelleher Cecily for the Lifeways Cross-Generation Cohort Study Group. Grand-parental factors associated with grandchildren’s asthma status in early childhood: En: 1st ed. SEPIASHVILI REVAZ, editor. ALLERGY, ASTHMA, COPD, IMMUNOPHYSIOLOGY & NOREHABILITOLOGY E INNOVATIVE TECHNOLOGIES. 1st ed. Bologna (Italy): Filodiritto Publisher, 2017. P. 123-131.
Bruna Galobardes, Raquel Granell, Jonathan Sterne, Rachael Hughes, Cilia Mejia-Lancheros, George Davey Smith, John Henderson Childhood wheezing, asthma, allergy, atopy and lung function: different socioeconomic patterns for different phenotypes. Am J Epidemiol. 2015;182(9):763-74. doi: 10.1093/aje/kwv04510.
Coma Auli N, Mejía-Lancheros C, Berenguera A, Pujol-Ribera E. Risk Perception of Sexually Transmitted Infections and HIV in Nigerian Commercial Sex Workers in Barcelona. A qualitative study. BMJ Open. 2015;5 (6):e006928. doi: 10.1136/bmjopen-2014-006928.
Mejía-Lancheros C, Estruch R, Martínez-González MA, Salas-Salvadó J, Castañer O, Corella D, Arós F, Gómez-Gracia E, Fiol M, Lapetra J, Serra-Majem L, Pintó X, Ros E, Díez-Espino J, Basora J, Sorlí JV, Lamuela-Raventos RM, Ruiz-Gutiérrez V, Muñoz MÁ; PREDIMED Study Investigators. Impact of psychosocial factors on cardiovascular morbimortality: a prospective cohort study. BMC Cardiovasc Disord. 2014; 14:135. doi: 10.1186/1471-2261-14-135.
Mejia-Lancheros C, Estruch R, Martínez-González MA, Salas-Salvadó J, Corella D, Gómez- Gracia E, Fiol M, Santos JM, Fitó M, Arós F, Serra-Majem L, Pintó X, Basora J, Sorlí JV, Muñoz MA; PREDIMED Study Investigators. Blood pressure values and depression in hypertensiveindividuals at high cardiovascular risk. BMC Cardiovasc Disord. 2014; 14:109. doi: 10.1186/1471- 2261-14-19.
Mejia-Lancheros C, Estruch R, Martínez-González MA, Salas-Salvadó J, Corella D, Gómez- Gracia E, Fiol M, Lapetra J, Covas MI, Arós F, Serra-Majem L, Pintó X, Basora J, Sorlí JV, Muñoz MA; PREDIMED Study Investigators. Socioeconomic status and health inequalities for cardiovascular prevention among elderly Spaniards. Rev Esp Cardiol (Engl Ed). 2013;66(10):803- 11. doi: 10.1016/j.rec.2013.05.025.
Coma Auli N, Mejía-Lancheros C, Berenguera A, Mayans MV, Lasagabaster MA, Pujol-Ribera E. Risk perception of sexually transmitted infections and HIV in Nigerian commercial sex workers living in Barcelona: a study protocol. BMJ Open. 2013;3(7). pii: e003345. doi:1136/bmjopen– 2013-003345.