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Avogo WA. Community characteristics and the risk of non-communicable diseases in Ghana. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000692. [PMID: 36962739 PMCID: PMC10021620 DOI: 10.1371/journal.pgph.0000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 12/12/2022] [Indexed: 06/18/2023]
Abstract
Non-communicable Diseases (NCDs) are rising quickly in low- and middle- income countries. In Ghana, chronic diseases are major causes of morbidity and mortality, yet data and the evidence- base for awareness, detection, and management of NCDs are lacking. Using data from the 2014 Ghana Demographic and Health Survey (GDHS), the first national study with information on hypertension and other risk factors, we examine the correlates and community characteristics associated with the risk of hypertension, obesity, and anemia among women. We find that hypertension prevalence in Ghana was 16 percent and 17 percent were overweight/obese, while 41 percent had anemia of any form. On community characteristics, the level of poverty in a community was significantly associated with lower risks of all three NCDs, while the aggregate level of employment had higher risks. On individual characteristics, the wealth of a household, women's educational level and urban residence were significant predictors of NCDs. We interpret the findings within the literature on neighborhood characteristics, the social gradient of health and in the context of speeding up the attainment of the Sustainable Development Goals (SGDS) to reduce premature deaths by one-third by 2030.
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Affiliation(s)
- Winfred A. Avogo
- Department of Sociology and Anthropology, Illinois State University, Normal, Illinois, United States of America
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2
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Jaguga F, Kiburi SK, Temet E, Barasa J, Karanja S, Kinyua L, Kwobah EK. A systematic review of substance use and substance use disorder research in Kenya. PLoS One 2022; 17:e0269340. [PMID: 35679248 PMCID: PMC9186181 DOI: 10.1371/journal.pone.0269340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 05/18/2022] [Indexed: 12/27/2022] Open
Abstract
Objectives The burden of substance use in Kenya is significant. The objective of this
study was to systematically summarize existing literature on substance use
in Kenya, identify research gaps, and provide directions for future
research. Methods This systematic review was conducted in line with the PRISMA guidelines. We
conducted a search of 5 bibliographic databases (PubMed, PsychINFO, Web of
Science, Cumulative Index of Nursing and Allied Professionals (CINAHL) and
Cochrane Library) from inception until 20 August 2020. In addition, we
searched all the volumes of the official journal of the National Authority
for the Campaign Against Alcohol & Drug Abuse (the African Journal of
Alcohol and Drug Abuse). The results of eligible studies have been
summarized descriptively and organized by three broad categories including:
studies evaluating the epidemiology of substance use, studies evaluating
interventions and programs, and qualitative studies exploring various themes
on substance use other than interventions. The quality of the included
studies was assessed with the Quality Assessment Tool for Studies with
Diverse Designs. Results Of the 185 studies that were eligible for inclusion, 144 investigated the
epidemiology of substance use, 23 qualitatively explored various substance
use related themes, and 18 evaluated substance use interventions and
programs. Key evidence gaps emerged. Few studies had explored the
epidemiology of hallucinogen, prescription medication, ecstasy, injecting
drug use, and emerging substance use. Vulnerable populations such as
pregnant women, and persons with physical disability had been
under-represented within the epidemiological and qualitative work. No
intervention study had been conducted among children and adolescents. Most
interventions had focused on alcohol to the exclusion of other prevalent
substances such as tobacco and cannabis. Little had been done to evaluate
digital and population-level interventions. Conclusion The results of this systematic review provide important directions for future
substance use research in Kenya. Systematic review registration PROSPERO: CRD42020203717.
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Affiliation(s)
- Florence Jaguga
- Department of Mental Health, Moi Teaching & Referral Hospital,
Eldoret, Kenya
- * E-mail:
| | | | - Eunice Temet
- Department of Mental Health & Behavioral Sciences, Moi University
School of Medicine, Eldoret, Kenya
| | - Julius Barasa
- Population Health, Academic Model Providing Access to Healthcare,
Eldoret, Kenya
| | - Serah Karanja
- Department of Mental Health, Gilgil Sub-County Hospital, Gilgil,
Kenya
| | - Lizz Kinyua
- Intensive Care Unit, Aga Khan University Hospital, Nairobi,
Kenya
| | - Edith Kamaru Kwobah
- Department of Mental Health, Moi Teaching & Referral Hospital,
Eldoret, Kenya
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Kuti MA, Bamidele OT, Udeh CT, Eseile BJ, Ogundeji OA. Appropriate use of plasma glucose tests for diagnosis of diabetes mellitus in Ibadan, Nigeria. Afr J Lab Med 2022; 11:1433. [PMID: 35547334 PMCID: PMC9082232 DOI: 10.4102/ajlm.v11i1.1433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/07/2022] [Indexed: 01/09/2023] Open
Abstract
Background: Diabetes mellitus is a growing epidemic in Africa. Its diagnosis relies exclusively on laboratory evidence, which differs based on clinical circumstances.Objective: The study described the appropriateness of plasma glucose test requests per the American Diabetes Association criteria.Methods: We reviewed the plasma glucose test requests received by the chemical pathology laboratory of the University College Hospital, Ibadan, Nigeria between June 2018 and November 2018. The American Diabetes Association diabetes diagnostic criteria were used to define the appropriateness of test requests and determine the potential for ill-informed clinical decisions.Results: Four hundred and twenty-three requisition forms were included, with the majority from the medical wards/clinics (72.3%); the most frequent reason for a plasma glucose test was systemic hypertension (28.6%). Fasting plasma glucose was most requested (254; 60.0%). One hundred and sixteen (27.4%) requests were potentially inappropriate, with the 2-h postprandial plasma glucose (2hPPG) test requests (83; 71.6%) being the most inappropriate. The difference in the proportion of inappropriate requests was not statistically significantly between medical or surgical wards/clinics (Odds ratio 1.131, 95% confidence interval 0.709–1.803, p = 0.605). Inappropriate requests in six cases may have triggered inappropriate action.Conclusion: A third of the glucose tests requested for querying diabetes mellitus may have been inappropriate. Results of such testing may trigger inappropriate clinical action. To improve the quality of care and for economic reasons, laboratories should have programmes to improve the appropriate use of their services.
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Affiliation(s)
- Modupe A Kuti
- Department of Chemical Pathology, Faculty of Basic Medical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Chemical Pathology, University College Hospital, Ibadan, Nigeria
| | - Olabisi T Bamidele
- Department of Chemical Pathology, University College Hospital, Ibadan, Nigeria
| | - Chioma T Udeh
- Department of Chemical Pathology, University College Hospital, Ibadan, Nigeria
| | - Bola J Eseile
- Department of Chemical Pathology, University College Hospital, Ibadan, Nigeria
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Mkuu RS, Gilreath TD, Barry AE, Nafukho FM, Rahman J, Chowdhury MAB, Wekullo C, Harvey IS. Identifying individuals with multiple non-communicable disease risk factors in Kenya: a latent class analysis. Public Health 2021; 198:180-186. [PMID: 34461453 DOI: 10.1016/j.puhe.2021.07.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 06/16/2021] [Accepted: 07/26/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Non-communicable diseases (NCDs) are the leading causes of death globally. In Kenya, the number of deaths resulting from NCDs is projected to surpass malaria and tuberculosis by 2030. Studies in Kenya show increasing NCDs; the aim of the present study is to examine the clustering of NCDs and risk factors in Kenya. STUDY DESIGN This is a cross-sectional study using data from the 2015 Kenya STEPwise Survey. METHODS This study examined relationships between NCDs (e.g. obesity, hypertension and diabetes) and health behaviours (e.g. sedentary activity, and fruit and vegetable consumption). Survey probability weights, which estimated the sampling design effect, were applied to consider the sampling units, and stratifications were used during sampling so that the results could be generalisable to the national adult Kenyan population. In total, 4350 adults were included in the study sample. RESULTS Overall, 24.43% of participants were classified as having hypertension, 1.88% as having type 2 diabetes, and 27.94% were classified as being overweight or obese. The best-fit model was a four-class solution. Class 1 is best described as 'young with high NCD risk' and had the highest sedentary activity. Class 2 is best described as 'poor rural with lower NCD risk' with a high chance of smoking and alcohol consumption. Class 3 is best described as 'rural with high NCD risk' and had the highest fruit and vegetable consumption. Class 4 is best described as 'wealthy young urban dwellers with high NCD risk' with a high chance of alcohol consumption and smoking. Individuals in Class 4 had the highest chance (40%) of being overweight/obese, a 2% chance of type 2 diabetes and a 23% chance of having hypertension. CONCLUSIONS NCDs are clustered in groups with high-risk behaviours. The group with the highest chance of having NCDs also had the highest chance of engaging in high-risk behaviours. The findings of this study suggest that smoking and alcohol consumption increase NCD risk in rural areas. Tailored and targeted interventions are needed to curb the increasing NCD prevalence in Kenya.
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Affiliation(s)
- R S Mkuu
- University of Florida, College of Medicine, Gainesville, FL, USA.
| | - T D Gilreath
- Texas A&M University, Transdisciplinary Center for Health Equity Research, College Station, TX, USA.
| | - A E Barry
- Texas A&M University, Department of Health and Kinesiology, College Station, TX, USA.
| | - F M Nafukho
- Texas A&M University, College of Education and Human Development, College Station, TX, USA.
| | - J Rahman
- BRAC University, Dhaka, Bangladesh.
| | - M A B Chowdhury
- University of Florida, College of Medicine, Gainesville, FL, USA.
| | - C Wekullo
- Masinde Muliro University of Science and Technology, Kakamega, Kenya.
| | - I S Harvey
- Texas A&M University, Department of Health and Kinesiology, College Station, TX, USA.
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Hanna DR, Campbell JA, Walker RJ, Dawson AZ, Egede LE. Association between Health and Wealth among Kenyan Adults with Hypertension. Glob J Health Sci 2021; 13:86-94. [PMID: 34113407 PMCID: PMC8188623 DOI: 10.5539/gjhs.v13n4p86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: This paper examines the relationship between hypertension and wealth in a national sample of Kenyan adults. Methods: Data from 27,552 individuals from the Demographic and Health Survey Program (DHS) for Kenya were analyzed. Wealth index, a cumulative measure of household standard of living, was the outcome. The final analysis was stratified by gender with covariates added in blocks (demographics, economic, and cultural) to investigate the independent association of hypertension with wealth index. Results: Approximately 7.6% of those with hypertension had a wealth index above the median. For women and men, hypertension was significantly associated with higher wealth index (women ß=0.26; CI=0.19; 0.34; men ß=0.36; CI=0.19; 0.53). After adjusting for age, rural location, children, employment, education, ethnicity, and religion, hypertension maintained statistical significance with wealth index for both women and men (women ß=0.06; CI=0.01; 0.11; men ß=0.20; CI=0.08; 0.31). Conclusions: As Kenya as a nation undergoes health care reform while also experiencing a high burden of hypertension, the results presented here provide preliminary evidence that may be used in support for decision makers for the wealth effects of health interventions. Additional work is needed to understand the longitudinal relationship between hypertension and wealth at the national level.
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Affiliation(s)
- Daniel R Hanna
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jennifer A Campbell
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, United States.,Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Rebekah J Walker
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, United States.,Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Aprill Z Dawson
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, United States.,Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Leonard E Egede
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, United States.,Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
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Reframing Non-Communicable Diseases and Injuries for Equity in the Era of Universal Health Coverage: Findings and Recommendations from the Kenya NCDI Poverty Commission. Ann Glob Health 2021; 87:3. [PMID: 33505862 PMCID: PMC7792462 DOI: 10.5334/aogh.3085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Kenya has implemented a robust response to non-communicable diseases and injuries (NCDIs); however, key gaps in health services for NCDIs still exist in the attainment of Universal Health Coverage (UHC). The Kenya Non-Communicable Diseases and Injury (NCDI) Poverty Commission was established to estimate the burden of NCDIs, determine the availability and coverage of health services, prioritize an expanded set of NCDI conditions, and propose cost-effective and equity-promoting interventions to avert the health and economic consequences of NCDIs in Kenya. Methods Burden of NCDIs in Kenya was determined using desk review of published literature, estimates from the Global Burden of Disease Study, and secondary analysis of local health surveillance data. Secondary analysis of nationally representative surveys was conducted to estimate current availability and coverage of services by socioeconomic status. The Commission then conducted a structured priority setting process to determine priority NCDI conditions and health sector interventions based on published evidence. Findings There is a large and diverse burden of NCDIs in Kenya, with the majority of disability-adjusted life-years occurring before age of 40. The poorest wealth quintiles experience a substantially higher deaths rate from NCDIs, lower coverage of diagnosis and treatment for NCDIs, and lower availability of NCDI-related health services. The Commission prioritized 14 NCDIs and selected 34 accompanying interventions for recommendation to achieve UHC. These interventions were estimated to cost $11.76 USD per capita annually, which represents 15% of current total health expenditure. This investment could potentially avert 9,322 premature deaths per year by 2030. Conclusions and Recommendations An expanded set of priority NCDI conditions and health sector interventions are required in Kenya to achieve UHC, particularly for disadvantaged socioeconomic groups. We provided recommendations for integration of services within existing health services platforms and financing mechanisms and coordination of whole-of-government approaches for the prevention and treatment of NCDIs.
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Gatimu SM, John TW. Socioeconomic inequalities in hypertension in Kenya: a decomposition analysis of 2015 Kenya STEPwise survey on non-communicable diseases risk factors. Int J Equity Health 2020; 19:213. [PMID: 33267846 PMCID: PMC7709247 DOI: 10.1186/s12939-020-01321-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND One in four Kenyans aged 18-69 years have raised blood pressure. Despite this high prevalence of hypertension and known association between socioeconomic status and hypertension, there is limited understanding of factors explaining inequalities in raised blood pressure in Kenya. Hence, we quantified the socioeconomic inequality in hypertension in Kenya and decomposed the determinants contributing to such inequality. METHODS We used data from the 2015 Kenya STEPwise survey for non-communicable diseases risk factors. We included 4422 respondents aged 18-69 years. We estimated the socioeconomic inequality using the concentration index (C) and decomposed the C using Wagstaff decomposition analysis. RESULTS The overall concentration index of hypertension in Kenya was - 0.08 (95% CI: - 0.14, - 0.02; p = 0.005), showing socioeconomic inequalities in hypertension disfavouring the poor population. About half (47.1%) of the pro-rich inequalities in hypertension was explained by body mass index while 26.7% by socioeconomic factors (wealth index (10.4%), education (9.3%) and paid employment (7.0%)) and 17.6% by sociodemographic factors (female gender (10.5%), age (4.3%) and marital status (0.6%)). Regional differences explained 7.1% of the estimated inequality with the Central region alone explaining 6.0% of the observed inequality. Our model explained 99.7% of the estimated socioeconomic inequality in hypertension in Kenya with a small non-explained part of the inequality (- 0.0002). CONCLUSION The present study shows substantial socioeconomic inequalities in hypertension in Kenya, mainly explained by metabolic risk factors (body mass index), individual health behaviours, and socioeconomic factors. Kenya needs gender- and equity-focused interventions to curb the rising burden of hypertension and inequalities in hypertension.
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Onyango EM, Onyango BM. The Rise of Noncommunicable Diseases in Kenya: An Examination of the Time Trends and Contribution of the Changes in Diet and Physical Inactivity. J Epidemiol Glob Health 2019; 8:1-7. [PMID: 30859780 PMCID: PMC7325816 DOI: 10.2991/j.jegh.2017.11.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 11/18/2017] [Indexed: 01/02/2023] Open
Abstract
This study examined correlations of historical changes in diet and physical inactivity with the rise of noncommunicable diseases (NCDs) in Kenya. Historical data on diet, wage jobs by industry, urbanization, gross domestic product (GDP), and morbidity due to NCDs were extracted from Kenya Statistical Abstracts, Food and Agriculture Organization (FAOSTAT), and the World Bank online database. These data were plotted and correlations between these factors and the incidence of different NCDs over time were evaluated. There was a rapid rise in the incidence of circulatory disease starting in 2001, and of hypertension and diabetes starting in 2008. The rise of these NCDs, especially hypertension and diabetes, was accompanied over the same period by a rise in per capita GDP and physical inactivity (as measured by increased urbanization and declining proportion of agricultural and forestry wage jobs); a rise in per capita supply of rice, wheat and its products, and cooking oils; and a decline in the per capita supply of maize and sugar. In conclusion, the positive correlations between indicators of dietary consumption and physical inactivity and rates of hypertension, circulatory disease, and diabetes suggest that the rapid rise of NCDs in Kenya may be, in part, due to changes in these modifiable factors.
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Affiliation(s)
- Edward Michieka Onyango
- Department of Health Sciences, College of Public Health, East Tennessee State University, Johnson City, TN 37604, USA.,MPH Program, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Benjamin Moranga Onyango
- Department of Agribusiness, Agricultural Education and Communication, Missouri State University, Springfield, MO, USA
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Mkuu RS, Gilreath TD, Wekullo C, Reyes GA, Harvey IS. Social determinants of hypertension and type-2 diabetes in Kenya: A latent class analysis of a nationally representative sample. PLoS One 2019; 14:e0221257. [PMID: 31425539 PMCID: PMC6699668 DOI: 10.1371/journal.pone.0221257] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 08/03/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Cardiovascular disease is among the leading causes of death in Kenya and type II diabetes (T2D) is a growing chronic health concern in the country. However, a gap exists in examining how demographic and social characteristics coalesce to identify individuals at high risk for hypertension and/or T2D in Kenya. The current study examined demographic typologies associated with self-report diagnoses. Methods Nationally representative cross-sectional study using 43,898 individuals from the Kenya Demographic and Health Survey 2014. Main Outcome Measures were self-reported Hypertension and Type 2 Diabetes diagnosis. Descriptive analyses were conducted using STATA 14. Latent class analysis (LCA) was conducted using Mplus 7.4. Results Approximately 5% reported hypertension and 1% reported T2D. Latent class analysis suggested a 4-class solution. The class with the highest likelihood to report previous diagnosis of hypertension (10.4%), consisted of high proportion of married adult women. The second highest prevalence of previous diagnosis of hypertension (4.4%) consisted of a high proportion of married middle aged men with high probability of being smokers. The results suggest that Kenyan women over 30 years may be at increased risk of hypertension compared to men. Future studies should include additional socio-demographic and behavioral characteristics to better understand gender differences in correlates for hypertension to be used for targeted and tailored health promotion-interventions.
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Affiliation(s)
- Rahma S. Mkuu
- Transdisciplinary Center for Health Equity Research, Department of Health & Kinesiology, Texas A&M University, College Station, Texas, United States of America
- * E-mail:
| | - Tamika D. Gilreath
- Transdisciplinary Center for Health Equity Research, Department of Health & Kinesiology, Texas A&M University, College Station, Texas, United States of America
| | - Caroline Wekullo
- Post Graduate Studies, Masinde Muliro University of Science and Technology, Kakamega, Kenya
| | - Gabriela A. Reyes
- Colorado School of Public Health, Colorado University, Denver-Anschutz Medical Campus, Denver, Colorado, United States of America
| | - Idethia S. Harvey
- Transdisciplinary Center for Health Equity Research, Department of Health & Kinesiology, Texas A&M University, College Station, Texas, United States of America
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Abstract
Background: Evidence from the developed world associates higher prevalence of hypertension with lower socioeconomic status (SES). However, patterns of association are not as clear in Africa and other developing countries, with varying levels of socioeconomic development and epidemiological transition. Using wealth and education as indicators, we investigated association between SES and hypertension among older adult women in Sudan and examined whether urbanicity mediates the relationship. Methods: The sample included women aged 50 years and over participating in the nationally representative population-based second Sudan Health Household Survey (SHHS) conducted in 2010. Principal components analysis was used to assign each household with a wealth score based on assets owned. The score was categorized into quintiles from lowest (poorest) to highest (richest). Findings: The sample included a total of 5218 women, median and mean age 55 and 59 years, respectively, with the majority not have any schooling (81.6%). The overall prevalence of reported hypertension was found to be 10.5%. After adjustment for age, marital status, work status and urban/rural location, better wealth and higher education were independently and positively associated with hypertension prevalence rates. However, when stratified by urbanicity, the relationship between wealth and hypertension lost its significance for women in urban areas but maintained it in rural areas, increasing significantly and consistently with each increase in quintile index (adjusted odds ratio, aOR1 = 1.95 95% CI = 1.08–3.52; aOR2 = 5.25, 95% CI = 3.01–9.15; aOR3 = 8.27, 95% CI = 4.78–14.3; and aOR4 = and 11.4, 95% CI = 6.45–20.0; respectively). By contrast, education played a greater role in increasing the odds of hypertension among women in urban locations but not in rural locations (aOR = 2.14, 95% CI = 1.25–7.90 vs. aOR = 0.79, 95% CI = 0.27–2.30, respectively). Conclusions: Our findings of a socioeconomic gradient in the prevalence of hypertension among women, mediated by urbanization, call for targeted interventions from early stages of economic development in Sudan and similar settings of transitioning countries.
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Munthali RJ, Manyema M, Said-Mohamed R, Kagura J, Tollman S, Kahn K, Gómez-Olivé FX, Micklesfield LK, Dunger D, Norris SA. Body composition and physical activity as mediators in the relationship between socioeconomic status and blood pressure in young South African women: a structural equation model analysis. BMJ Open 2018; 8:e023404. [PMID: 30573484 PMCID: PMC6303607 DOI: 10.1136/bmjopen-2018-023404] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 11/08/2018] [Accepted: 11/09/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Varying hypertension prevalence across different socioeconomic strata within a population has been well reported. However, the causal factors and pathways across different settings are less clear, especially in sub-Saharan Africa. Therefore, this study aimed to compare blood pressure (BP) levels and investigate the extent to which socioeconomic status (SES) is associated with BP, in rural and urban South Africa women. SETTING Rural and urban South Africa. DESIGN Cross-sectional. PARTICIPANTS Cross-sectional data on SES, total moderate and vigorous physical activity (MVPA), anthropometric and BP were collected on rural (n=509) and urban (n=510) young black women (18-23 years age). Pregnant and mentally or physically disabled women were excluded from the study. RESULTS The prevalence of combined overweight and obesity (46.5% vs 38.8%) and elevated BP (27.0% vs 9.3%) was higher in urban than rural women, respectively. Results from the structural equation modelling showed significant direct positive effects of body mass index (BMI) on systolic BP (SBP) in rural, urban and pooled datasets. Negative direct effects of SES on SBP and positive total effects of SES on SBP were observed in the rural and pooled datasets, respectively. In rural young women, SES had direct positive effects on BMI and was negatively associated with MVPA in urban and pooled analyses. BMI mediated the positive total effects association between SES and SBP in pooled analyses (ß 0.46; 95% CI 0.15 to 0.76). CONCLUSIONS Though South Africa is undergoing nutritional and epidemiological transitions, the prevalence of elevated BP still varies between rural and urban young women. The association between SES and SBP varies considerably in economically diverse populations with BMI being the most significant mediator. There is a need to tailor prevention strategies to take into account optimising BMI when designing strategies to reduce future risk of hypertension in young women.
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Affiliation(s)
- Richard J Munthali
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mercy Manyema
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Rihlat Said-Mohamed
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Juliana Kagura
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Umeå Centre for Global Health Research, Umeå, Sweden
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Umeå Centre for Global Health Research, Umeå, Sweden
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa K Micklesfield
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - David Dunger
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics, MRL Wellcome Trust-MRC Institute of Metabolic Science, NIHR Cambridge Comprehensive Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Shane A Norris
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Shin WY, Kim HC, Lee T, Jeon DH, Ha KH, Kim DJ, Chang HJ. Combined effects of diabetes and low household income on mortality: a 12-year follow-up study of 505 677 Korean adults. Diabet Med 2018; 35:1345-1354. [PMID: 29851428 DOI: 10.1111/dme.13695] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2018] [Indexed: 12/20/2022]
Abstract
AIM To examine the effects of diabetes, low income and their combination on mortality in the Korean population. METHODS We analysed a total of 505 677 people (53.9% male) aged 40-79 years old from the National Health Insurance Service-National Health Screening (NHIS-HEALS) cohort. Ten levels of household income were used as indicators of economic status. Diabetes was defined as elevated fasting blood glucose (≥ 6.9 mmol/l) and/or use of glucose-lowering drugs or insulin. Covariates of age, sex, BMI, smoking and Charlson Comorbidity Index were determined at baseline. Outcomes were total and cause-specific mortality over 12 years. Cox's proportional hazard regression models were used to estimate hazard ratios (HRs) for mortality according to the presence of diabetes, household income and their combination. RESULTS Lower household income was associated with higher mortality from all causes, cardiovascular disease, cancer and non-cancer non-cardiovascular causes. Excessive mortality due to low incomes was observed in both people with and without diabetes. In men, the adjusted HR [95% confidence interval (CI)] of mortality was 1.38 (1.34 to 1.42) for low-income only, 1.48 (1.42 to 1.55) for diabetes only and 1.95 (1.86 to 2.05) for diabetes and low-income combined, relative to the normal glucose and high income group. Corresponding HR (95% CI) in women were 1.19 (1.14 to 1.24), 1.54 (1.44 to 1.64) and 1.87 (1.75 to 2.01), respectively. CONCLUSION Both low household income and the presence of diabetes independently increase the risk of mortality, but their combined effects on mortality may be different between men and women.
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Affiliation(s)
- W Y Shin
- Cardiovascular and Metabolic Disease Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - H C Kim
- Cardiovascular and Metabolic Disease Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - T Lee
- Department of Applied Statistics, Yonsei University, Seoul, Korea
| | - D-H Jeon
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - K H Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - D J Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - H-J Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
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Williams J, Allen L, Wickramasinghe K, Mikkelsen B, Roberts N, Townsend N. A systematic review of associations between non-communicable diseases and socioeconomic status within low- and lower-middle-income countries. J Glob Health 2018; 8:020409. [PMID: 30140435 PMCID: PMC6076564 DOI: 10.7189/jogh.08.020409] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Non-communicable diseases (NCDs) are the leading cause of death globally. Eighty-two percent of premature NCD deaths occur within low- and lower middle-income countries (LLMICs). Research to date, largely drawn from high-income countries, suggests that disadvantaged and marginalized groups have a higher NCD burden, but there has been a dearth of research studying this relationship within LLMICs. The purpose of this systematic review is to map the literature on evidence from LLMICs on the socio-economic status (SES) gradient of four particular NCDs: cardiovascular disease, cancer, diabetes, and chronic respiratory diseases. Methods We conducted a comprehensive literature search for primary research published between 1 January 1990 and 27 April 2015 using six bibliographic databases and web resources. We included studies that reported SES and morbidity or mortality from cardiovascular disease, cancer, diabetes and chronic respiratory diseases within LLMICs. Results Fifty-seven studies from 17 LLMICs met our inclusion criteria. Fourteen of the 18 papers that reported significant associations between cancer and SES suggested that low SES groups had the highest cancer risk. Eleven of 15 papers reporting significant relationships between CVD and SES suggested that low SES groups have higher risk. In contrast, seven of 12 papers reporting significant findings related to diabetes found that higher SES groups had higher diabetes risk. We identified just three studies on the relationship between chronic respiratory diseases and SES; none of them reported significant findings. Conclusions Only 17 of the 84 LLMICs were represented, highlighting the need for more research on NCDs within these countries. The majority of studies were medium to high quality cross-sectional studies. When we restricted our analyses to high quality studies only, for both cancer and cardiovascular disease more than half of studies found a significantly higher risk for those of lower SES. The opposite was true for diabetes, whilst there was a paucity of high quality research on chronic respiratory disease. Development programmes must consider health alongside other aims and NCD prevention interventions must target all members of the population. Systematic review registration number Prospero: CRD42015020169.
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Affiliation(s)
- Julianne Williams
- Centre for Population-based Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Luke Allen
- Centre for Population-based Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kremlin Wickramasinghe
- Centre for Population-based Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Bente Mikkelsen
- Secretariat of the WHO Global Coordination Mechanisms on the Prevention and Control of Non-communicable diseases, World Health Organization, Geneva, Switzerland
| | - Nia Roberts
- Health Care Libraries, Bodleian Libraries, University of Oxford, Oxford, UK
| | - Nick Townsend
- Centre for Population-based Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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14
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The contribution of health behaviors to socioeconomic inequalities in health: A systematic review. Prev Med 2018; 113:15-31. [PMID: 29752959 DOI: 10.1016/j.ypmed.2018.05.003] [Citation(s) in RCA: 197] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 05/02/2018] [Accepted: 05/05/2018] [Indexed: 12/22/2022]
Abstract
Unhealthy behaviors and their social patterning have been frequently proposed as factors mediating socioeconomic differences in health. However, a clear quantification of the contribution of health behaviors to the socioeconomic gradient in health is lacking. This study systematically reviews the role of health behaviors in explaining socioeconomic inequalities in health. Published studies were identified by a systematic review of PubMed, Embase and Web-of-Science. Four health behaviors were considered: smoking, alcohol consumption, physical activity and diet. We restricted health outcomes to cardiometabolic disorders and mortality. To allow comparison between studies, the contribution of health behaviors, or the part of the socioeconomic gradient in health that is explained by health behaviors, was recalculated in all studies according to the absolute scale difference method. We identified 114 articles on socioeconomic position, health behaviors and cardiometabolic disorders or mortality from electronic databases and articles reference lists. Lower socioeconomic position was associated with an increased risk of all-cause mortality and cardiometabolic disorders, this gradient was explained by health behaviors to varying degrees (minimum contribution -43%; maximum contribution 261%). Health behaviors explained a larger proportion of the SEP-health gradient in studies conducted in North America and Northern Europe, in studies examining all-cause mortality and cardiovascular disease, among men, in younger individuals, and in longitudinal studies, when compared to other settings. Of the four behaviors examined, smoking contributed the most to social inequalities in health, with a median contribution of 19%. Health behaviors contribute to the socioeconomic gradient in cardiometabolic disease and mortality, but this contribution varies according to population and study characteristics. Nevertheless, our results should encourage the implementation of interventions targeting health behaviors, as they may reduce socioeconomic inequalities in health and increase population health.
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15
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Mahmud I, Clarke L, Ploubidis GB. Socio-demographic determinants of the severity of locomotor disability among adults in Bangladesh: a cross-sectional study, December 2010-February 2011. ACTA ACUST UNITED AC 2017; 75:47. [PMID: 29181151 PMCID: PMC5694906 DOI: 10.1186/s13690-017-0217-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 07/05/2017] [Indexed: 11/10/2022]
Abstract
Background Socio-demographic variables are widely known to have an association with the presence of any disability. However, the association between the severity of locomotor disability and socio-demographic variables has never been investigated in Bangladesh. Methods A cross sectional survey of adults with locomotor disabilities was conducted between December 2010 and February 2011 at the Centre for the Rehabilitation of the Paralysed (CRP), Dhaka, Bangladesh. During the study period 328 adults with locomotor disabilities met our selection criteria, but 316 consented and participated in the study. The 55-item Locomotor Disability Scale was used to measure disability. This study investigated the socio-demographic determinants of the severity of locomotor disability: age, gender, marital status, educational attainment, occupation, income status, type of house, living in own/rented house, household monthly income, household population and area of residence. Results Participants' age was positively associated with the severity of their locomotor disability (β = 0.01; 95% CI: 0.004 to 0.02), adjusting for diagnosis and other socio-demographic variables studied. Individuals who had an income experienced 0.35 (95% CI: -0.63 to -0.07) points decrease in the severity of disability than those did not have an income, adjusting for diagnosis and rest of the socio-demographic variables studied. In comparison to the unemployed individuals, students, homemakers, and individuals in elementary occupation respectively experienced 0.75 (95% CI: -1.08 to -0.43), 0.51 (95% CI: -0.82 to -0.19) and 0.37 (95% CI: -0.66 to -0.08) points decrease in the severity of locomotor disability, adjusting for diagnosis and rest of the socio-demographic variables studied. Conclusions The severity of locomotor disability has an association with individuals' age, income status and occupation of the adults with such disability in Bangladesh. No such association was evident with other socioeconomic position and demographic variables. This finding suggests that people with locomotor disabilities in Bangladesh experience similar disabling built and attitudinal environments irrespective of their socioeconomic positions and demographic characteristics. Further community-based studies are needed to confirm such conclusions.
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Affiliation(s)
- Ilias Mahmud
- James P Grant School of Public Health, BRAC University, 5th Floor icddr, b Building, 68 Shahid Tajuddin Ahmed Sharani Mohakhali, Dhaka, 1212 Bangladesh
| | - Lynda Clarke
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - George B Ploubidis
- Centre for Longitudinal Studies, Department of Social Science, University College London, 55 - 59 Gordon Square, London, WC1H 0NU UK
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16
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Multiple deprivation, vision loss, and ophthalmic disease in adults: global perspectives. Surv Ophthalmol 2017; 63:406-436. [PMID: 29100897 DOI: 10.1016/j.survophthal.2017.10.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 10/19/2017] [Accepted: 10/19/2017] [Indexed: 12/19/2022]
Abstract
The association between socioeconomic position and morbidity and mortality has long been recognized. We evaluate the evidence for an association between multiple aspects of deprivation and ocular health in a global context. This is a systematic review of studies that evaluated deprivation in the adult population in the context of the major acquired causes of visual loss such as cataract, diabetic eye disease, glaucoma, age-related macular degeneration, and ocular trauma. The search strategy identified relevant studies reported between 1946 and August 2016, with randomized control trials, case-control, cohort, and cross-sectional study designs being selected for inclusion. The studies identified in this review from across the world demonstrate the extent to which the common themes such as low educational attainment and low income may be associated with increased incidence of various sight-threatening conditions and may adversely affect access to specialist assessment and delivery of treatment. Health inequality may always persist, but an increased recognition of the importance of the various impacts of deprivation may empower policy makers to target limited resources to the most vulnerable groups in order to deliver the greatest benefit.
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17
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Addo J, Agyemang C, de-Graft Aikins A, Beune E, Schulze MB, Danquah I, Galbete C, Nicolaou M, Meeks K, Klipstein-Grobusch K, Bahendaka S, Mockenhaupt FP, Owusu-Dabo E, Kunst A, Stronks K, Smeeth L. Association between socioeconomic position and the prevalence of type 2 diabetes in Ghanaians in different geographic locations: the RODAM study. J Epidemiol Community Health 2017; 71:633-639. [PMID: 28348205 PMCID: PMC5485755 DOI: 10.1136/jech-2016-208322] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 01/15/2017] [Accepted: 02/13/2017] [Indexed: 11/21/2022]
Abstract
Background The prevalence of diabetes has been shown to be socially patterned but the direction of the association in low-income countries and among migrant populations in Europe has varied in the literature. This study examined the association between socioeconomic position (SEP) and diabetes in Ghanaians in Europe and in Ghana. Methods Data were derived from the multicentre Research on Obesity and Diabetes among African Migrants (RODAM) study of Ghanaian adults aged 25–70 years residing in Europe (Amsterdam, Berlin and London) and in urban and rural Ghana. Educational attainment (elementary, secondary or higher) and occupational class (low or high) were used as indicators of SEP. Age-standardised prevalence of diabetes and prevalence ratios were evaluated separately for men and women of different SEP in Ghana and Europe. Results A total of 5290 participants were included in the analyses. The prevalence of diabetes decreased with increasing level of education in Ghanaian men and women in Europe and in men in urban Ghana, whereas diabetes prevalence increased with increasing level of education in men and women in rural Ghana. The association between occupational class and the prevalence of diabetes followed a less consistent pattern in men and women in the different locations. Conclusions The association of diabetes and SEP differed in rural Ghana compared with urban settings in Ghana and Europe and comparing men and women, highlighting the complex interaction of SEP and the development of diabetes. These findings have important implications for diabetes prevention strategies in Ghanaians in different locations.
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Affiliation(s)
- Juliet Addo
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Charles Agyemang
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ama de-Graft Aikins
- Regional Institute for Population Studies, University of Ghana, Legon, Accra, Ghana
| | - Erik Beune
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Ina Danquah
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Cecilia Galbete
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Mary Nicolaou
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Karlijn Meeks
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Frank P Mockenhaupt
- Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Berlin, Germany
| | - Ellis Owusu-Dabo
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Anton Kunst
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Liam Smeeth
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Salem K, Kinsara AJ. Hypertension in low and middle-income countries: Challenges, gaps and limited resources specific strategies. World J Hypertens 2017; 7:19-23. [DOI: 10.5494/wjh.v7.i1.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/29/2016] [Accepted: 11/29/2016] [Indexed: 02/06/2023] Open
Abstract
In this article we aim to discuss the burden of hypertension in middle-income countries, the challenges and opportunities, identify some implementation gaps in some of the published initiatives and propose a few pillars that could benefit an upstream population health and health promotion. One billion people suffer from hypertension worldwide; however, the prevalence of hypertension in low and middle-income countries is higher than that in the industrialized countries. Hypertension affects 45% of African adults aged 25 and above, compared to the 36% North American prevalence rate; moreover, the death rate from hypertension in LMICs is higher the than that of the European countries (141 vs 93 per 10000, respectively). The association between increased systolic blood pressure and income reversed between the early 80s and the first decade of the 20th century; the higher the per capita income the lower the risk of hypertension. Hence, unless an effective interventions, such as improving diagnosis and treatment, lowering salt intake, enhancing access and availability of fresh fruit and vegetable, and increasing leisure time physical activities are implemented, then low income countries epidemic is inevitable. In this article we aim to discuss the global burden of hypertension in low and middle-income countries, the gaps and challenges, identify the high-risk groups and propose a prevention and cost effective treatment strategic framework.
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Stringhini S, Forrester TE, Plange-Rhule J, Lambert EV, Viswanathan B, Riesen W, Korte W, Levitt N, Tong L, Dugas LR, Shoham D, Durazo-Arvizu RA, Luke A, Bovet P. The social patterning of risk factors for noncommunicable diseases in five countries: evidence from the modeling the epidemiologic transition study (METS). BMC Public Health 2016; 16:956. [PMID: 27612934 PMCID: PMC5017030 DOI: 10.1186/s12889-016-3589-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 08/25/2016] [Indexed: 12/04/2022] Open
Abstract
Background Associations between socioeconomic status (SES) and risk factors for noncommunicable diseases (NCD-RFs) may differ in populations at different stages of the epidemiological transition. We assessed the social patterning of NCD-RFs in a study including populations with different levels of socioeconomic development. Methods Data on SES, smoking, physical activity, body mass index, blood pressure, cholesterol and glucose were available from the Modeling the Epidemiologic Transition Study (METS), with about 500 participants aged 25–45 in each of five sites (Ghana, South Africa, Jamaica, Seychelles, United States). Results The prevalence of NCD-RFs differed between these populations from five countries (e.g., lower prevalence of smoking, obesity and hypertension in rural Ghana) and by sex (e.g., higher prevalence of smoking and physical activity in men and of obesity in women in most populations). Smoking and physical activity were associated with low SES in most populations. The associations of SES with obesity, hypertension, cholesterol and elevated blood glucose differed by population, sex, and SES indicator. For example, the prevalence of elevated blood glucose tended to be associated with low education, but not with wealth, in Seychelles and USA. The association of SES with obesity and cholesterol was direct in some populations but inverse in others. Conclusions In conclusion, the distribution of NCD-RFs was socially patterned in these populations at different stages of the epidemiological transition, but associations between SES and NCD-RFs differed substantially according to risk factor, population, sex, and SES indicator. These findings emphasize the need to assess and integrate the social patterning of NCD-RFs in NCD prevention and control programs in LMICs.
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Affiliation(s)
- Silvia Stringhini
- University Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Biopôle 2, Route de la Corniche 10, 1010, Lausanne, Switzerland.
| | - Terrence E Forrester
- Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston, Jamaica
| | | | - Estelle V Lambert
- Research Unit for Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Walter Riesen
- Center for Laboratory Medicine, Canton Hospital, St. Gallen, Switzerland
| | - Wolfgang Korte
- Center for Laboratory Medicine, Canton Hospital, St. Gallen, Switzerland
| | - Naomi Levitt
- Chronic Disease Initiative in Africa, Department of Medicine, University of CapeTown, Cape Town, South Africa
| | - Liping Tong
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Lara R Dugas
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - David Shoham
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | | | - Amy Luke
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Pascal Bovet
- University Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Biopôle 2, Route de la Corniche 10, 1010, Lausanne, Switzerland.,Ministry of Health, Victoria, Republic of Seychelles
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20
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Chege PM. Multiple cardiovascular disease risk factors in rural Kenya: evidence from a health and demographic surveillance system using the WHO STEP-wise approach to chronic disease risk factor surveillance. S Afr Fam Pract (2004) 2016. [DOI: 10.1080/20786190.2015.1114703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Zhao Y, Crimmins EM, Hu P, Shen Y, Smith JP, Strauss J, Wang Y, Zhang Y. Prevalence, diagnosis, and management of diabetes mellitus among older Chinese: results from the China Health and Retirement Longitudinal Study. Int J Public Health 2016; 61:347-56. [PMID: 26755457 DOI: 10.1007/s00038-015-0780-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 11/19/2015] [Accepted: 12/18/2015] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To estimate prevalence of diabetes mellitus (DM), success in diagnosing, and methods of diabetes management in China. METHODS China Health and Retirement Longitudinal Study, a representative survey of the Chinese population at least 45 years old, is used to estimate diabetes and prediabetes prevalence, diagnosis, and treatment and their associations with residence, socioe-conomic, and demographic factors. RESULTS Almost 60 % of middle-aged and elderly Chinese have prediabetes or diabetes in 2011-2012. DM prevalence increases with age, but the oldest group is least likely to be diagnosed. Prevalence is higher with higher body mass index, fasting cholesterol, and larger waist circumference. Higher prevalence is found in urban areas among residents with urban registration status (the Chinese administrative registration system or hukou), especially in coastal regions. Better rates of diagnosis, management, and education regarding diabetes are strongly associated with urban hukou, living in coastal areas, and in families with higher per capita expenditures, the appropriate economic resources measure in China. CONCLUSIONS Diagnosis and management of diabetes is highly differential within China but recent efforts to improve health systems are succeeding in reducing undiagnosed disease. Current high prevalence of prediabetes suggests a more intensive effort is required in the future.
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Affiliation(s)
- Yaohui Zhao
- National School of Development, Peking University, Beijing, China.
| | - Eileen M Crimmins
- Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Peifeng Hu
- UCLA Division of Geriatric Medicine, Los Angeles, CA, USA
| | - Yang Shen
- UCLA Division of Endocrinology, Diabetes and Hypertension, Los Angeles, CA, USA
| | | | - John Strauss
- Department of Economics, University of Southern California, Los Angeles, CA, USA
| | - Yafeng Wang
- Institute for Social Science Survey, Peking University, Beijing, China
| | - Yuan Zhang
- Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
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Abstract
SummaryThis study’s objectives were, first, to examine the association between social engagement and the odds of taking hypertensive medications and treatment among adults in China; and second, to explore the lifestyle and psychological mechanisms underlying this association. Data were from the WHO Study on Global AGEing and Adult Health (WHO-SAGE), a national survey of 11,046 participants aged 18 to 69 conducted in China in 2010. The key outcome was a dichotomous indicator of whether the respondent was taking hypertensive medication or other treatment. A series of logistic regression models were fitted to examine the research questions. Higher levels of social engagement were found to be associated with a lower odds of taking hypertensive medication or treatment, and the association was stronger for women than for men. Lifestyle factors (i.e. smoking and BMI) and perceived overall life satisfaction were significant covariates. Life satisfaction helped explain some of the social engagement benefit for both men and women and BMI only appeared to be a mediator for men. Being married was not significantly associated with lower odds of taking hypertensive medication or treatment in either men or women. Social engagement seems to be protective against hypertension for adult men and women in China, although causation could not be determined in this cross-sectional study. Psychosocial mechanisms are probably at work, but these vary by gender.
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Prevalence and Clustering of Cardiovascular Disease Risk Factors among Tibetan Adults in China: A Population-Based Study. PLoS One 2015; 10:e0129966. [PMID: 26047133 PMCID: PMC4457922 DOI: 10.1371/journal.pone.0129966] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 05/14/2015] [Indexed: 11/19/2022] Open
Abstract
Objectives The prevalence of cardiovascular disease risk factors has increased worldwide. However, the prevalence and clustering of cardiovascular disease risk factors among Tibetans is currently unknown. We aimed to explore the prevalence and clustering of cardiovascular disease risk factors among Tibetan adults in China. Methods In 2011, 1659 Tibetan adults (aged ≥18 years) from Changdu, China were recruited to this cross-section study. The questionnaire, physical examinations and laboratory testing were completed and the prevalence of cardiovascular disease risk factors, including hypertension, diabetes, overweight/obesity, dyslipidemia, and current smoking, were counted. The association between the clustering of cardiovascular disease risk factors and demographic characteristics, and geographic altitude were assessed. Results The age-standardized prevalence of hypertension, diabetes, overweight or obesity, dyslipidemia, and current smoking were 62.4%, 6.4%, 34.3%, 42.7%, and 6.1%, respectively, and these risk factors were associated with age, gender, education level, yearly family income, altitude, occupation, and butter tea consumption (P < 0.05). Overall, the age-adjusted prevalence of clustering of ≥1, ≥2, and ≥3 cardiovascular disease risk factors were 79.4%, 47.1%, and 20.9%, respectively. There appeared higher clustering of ≥2 and ≥3 cardiovascular disease risk factors among Tibetans with higher education level and family income yearly, and those living at an altitude < 3500 m and in a township. Conclusions The prevalence of cardiovascular disease risk factors, especially hypertension, was high in Tibetans. Moreover, there was an increased clustering of cardiovascular disease risk factors among those with higher socioeconomic status, lamas and those living at an altitude < 3500 m. These findings suggest that without the immediate implementation of an efficient policy to control these risk factors, cardiovascular disease will eventually become a major disease burden among Tibetans.
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Life course research: new opportunities for establishing social and biological plausibility. Int J Public Health 2015; 60:629-30. [DOI: 10.1007/s00038-015-0688-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Kim SR, Han K, Choi JY, Ersek J, Liu J, Jo SJ, Lee KS, Yim HW, Lee WC, Park YG, Lee SH, Park YM. Age- and sex-specific relationships between household income, education, and diabetes mellitus in Korean adults: the Korea National Health and Nutrition Examination Survey, 2008-2010. PLoS One 2015; 10:e0117034. [PMID: 25622031 PMCID: PMC4306546 DOI: 10.1371/journal.pone.0117034] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 12/17/2014] [Indexed: 02/03/2023] Open
Abstract
Background To investigate the effects of age and sex on the relationship between socioeconomic status (SES) and the prevalence and control status of diabetes mellitus (DM) in Korean adults. Methods Data came from 16,175 adults (6,951 men and 9,227 women) over the age of 30 who participated in the 2008-2010 Korea National Health and Nutrition Examination Survey. SES was measured by household income or education level. The adjusted odds ratios (ORs) and corresponding 95% confidence intervals (95% CI) for the prevalence or control status of diabetes were calculated using multiple logistic regression analyses across household income quartiles and education levels. Results The household income-DM and education level-DM relationships were significant in younger age groups for both men and women. The adjusted ORs and 95% CI for diabetes were 1.51 (0.97, 2.34) and 2.28 (1.29, 4.02) for the lowest vs. highest quartiles of household income and education level, respectively, in women younger than 65 years of age (both P for linear trend < 0.05 with Bonferroni adjustment). The adjusted OR and 95% CI for diabetes was 2.28 (1.53, 3.39) for the lowest vs. highest quartile of household income in men younger than 65 (P for linear trend < 0.05 with Bonferroni adjustment). However, in men and women older than 65, no associations were found between SES and the prevalence of DM. No significant association between SES and the status of glycemic control was detected. Conclusions We found age- and sex-specific differences in the relationship of household income and education with the prevalence of DM in Korea. DM preventive care is needed for groups with a low SES, particularly in young or middle-aged populations.
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Affiliation(s)
- So-Ra Kim
- Graduate School of Public Health, The Catholic University of Korea, Seoul, Korea
| | - Kyungdo Han
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Young Choi
- Catholic Medical Center, The Catholic University of Korea, Seoul, Korea
| | - Jennifer Ersek
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, The University of South Carolina, Columbia, South Carolina, United States of America
| | - Junxiu Liu
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, The University of South Carolina, Columbia, South Carolina, United States of America
| | - Sun-Jin Jo
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kang-Sook Lee
- Graduate School of Public Health, The Catholic University of Korea, Seoul, Korea
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeon Woo Yim
- Graduate School of Public Health, The Catholic University of Korea, Seoul, Korea
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won-Chul Lee
- Graduate School of Public Health, The Catholic University of Korea, Seoul, Korea
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Gyu Park
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung-Hwan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St.Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- * E-mail: (YMP); (SHL)
| | - Yong-Moon Park
- Graduate School of Public Health, The Catholic University of Korea, Seoul, Korea
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, The University of South Carolina, Columbia, South Carolina, United States of America
- * E-mail: (YMP); (SHL)
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Seck SM, Dia DG, Doupa D, Diop-Dia A, Thiam I, Ndong M, Gueye L. Diabetes Burden in Urban and Rural Senegalese Populations: A Cross-Sectional Study in 2012. Int J Endocrinol 2015; 2015:163641. [PMID: 26491437 PMCID: PMC4605376 DOI: 10.1155/2015/163641] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 07/11/2015] [Accepted: 08/13/2015] [Indexed: 12/13/2022] Open
Abstract
Diabetes represents a challenging global health issue in the 21st century. Data from sub-Saharan African populations are scarce and are usually restricted to urban settings. The objective of this study was to compare prevalence and risk factors of diabetes in rural and urban areas in Senegal. Methods. In a community-based survey between January and May 2012, we included 1027 adults aged ≥18 years living in northern Senegal. Sociodemographic, clinical, and biological data were collected during household visits. Multivariate logistic regression was performed to identify factors associated with diabetes. Results. Mean age of participants was 48.0 ± 16.9 years and 65.7% were female. Participants from urban area represented 55.7%. The age-standardized prevalence of diabetes was 7.6% (6.0% in men versus 9.0% in women). Prevalence of diabetes was higher in urban areas (8.1%) compared to rural areas (4.6%). Disease awareness rate was 43%. After multivariate analysis, age (OR = 1.63, p = 0.001), familial history of diabetes (OR = 1.42, p = 0.001), and abdominal obesity (OR = 1.17, p = 0.05) were associated with diabetes. Conclusion. Diabetes is frequent in urban and rural areas in Senegal. Awareness rate is very low among populations. Age, family history of diabetes, and abdominal obesity are the main risk factors identified.
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Affiliation(s)
- S. M. Seck
- Faculty of Health Sciences, Gaston Berger University, Saint-Louis, Senegal
- *S. M. Seck:
| | - D. G. Dia
- Faculty of Health Sciences, Gaston Berger University, Saint-Louis, Senegal
| | - D. Doupa
- Faculty of Health Sciences, Gaston Berger University, Saint-Louis, Senegal
| | - A. Diop-Dia
- Faculty of Health Sciences, Gaston Berger University, Saint-Louis, Senegal
| | - I. Thiam
- Faculty of Health Sciences, Gaston Berger University, Saint-Louis, Senegal
| | - M. Ndong
- Nutrition Department, Faculty of Agronomic Sciences, Gaston Berger University, Saint-Louis, Senegal
| | - L. Gueye
- Faculty of Health Sciences, Gaston Berger University, Saint-Louis, Senegal
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Enduring inequality: educational disparities in health among the oldest old in Sweden 1992–2011. Int J Public Health 2014; 60:91-8. [DOI: 10.1007/s00038-014-0621-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 10/27/2014] [Accepted: 11/06/2014] [Indexed: 10/24/2022] Open
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Najafipour H, Nasri HR, Afshari M, Moazenzadeh M, Shokoohi M, Foroud A, Etemad K, Sadeghi B, Mirzazadeh A. Hypertension: diagnosis, control status and its predictors in general population aged between 15 and 75 years: a community-based study in southeastern Iran. Int J Public Health 2014; 59:999-1009. [PMID: 25227395 DOI: 10.1007/s00038-014-0602-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 08/23/2014] [Accepted: 08/25/2014] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Hypertension (HTN) is an important cause of cardiovascular related morbidity and mortality. This study aimed at providing the prevalence of pre-HTN, diagnosed and undiagnosed HTN, along with its control and associated factors in an adult population. METHODS 5,900 participants aged 15-75 years took part in the study. HTN was verified by examination, self-reported history or using anti-hypertensive drug(s). Pre-hypertension and hypertension were defined as 120-139/80-89 mmHg and >140/>90 mmHg for systolic/diastolic BP, respectively. RESULTS The prevalence of hypertension was 18.4 % from which 10.5 %were diagnosed and 7.9 % were undiagnosed. The prevalence of pre-HTN was 35.5 %. HTN increased by age (2.4 % in 15-24 to 49 % in 55-64 years). The men had higher pre-HTN (42.7 vs. 28.1 %) and undiagnosed HTN (11.3 vs. 4.6 %). Of those diagnosed, 56.3 % had uncontrolled BP levels. Smoking, anxiety, obesity, and positive family history of HTN were the most significant predictors for HTN. CONCLUSIONS Hypertension affected almost one-fifth of the population. Given the poor control in diagnosed hypertensive patients, it is alarming that the current health system in urban areas in Iran is not effective enough to control the epidemic spread of non-communicable diseases.
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Affiliation(s)
- Hamid Najafipour
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
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Janković S, Stojisavljević D, Janković J, Erić M, Marinković J. Status of cardiovascular health in a transition European country: findings from a population-based cross-sectional study. Int J Public Health 2014; 59:769-78. [DOI: 10.1007/s00038-014-0579-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 06/08/2014] [Accepted: 06/16/2014] [Indexed: 01/01/2023] Open
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Exploring differences in prevalence of diagnosed, measured and undiagnosed hypertension: the case of Ireland and the United States of America. Int J Public Health 2014; 59:759-67. [DOI: 10.1007/s00038-014-0573-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 05/09/2014] [Accepted: 06/02/2014] [Indexed: 01/13/2023] Open
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Living with diabetes and hypertension in Tunisia: popular perspectives on biomedical treatment. Int J Public Health 2014; 60 Suppl 1:S31-7. [PMID: 24924262 DOI: 10.1007/s00038-014-0572-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 05/13/2014] [Accepted: 05/14/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES The growing prevalence of non-communicable diseases across the Middle East and North Africa poses major challenges for underfunded health services. This article presents data on the perspectives of ordinary Tunisians who are coping with two of these diseases--diabetes and hypertension--and who are obtaining treatment through Tunisian public health clinics. Little has been written to date on patient experiences of biomedical treatment in Maghreb countries. METHODS Based on qualitative methods and semi-structured interviews with 24 patients attending two clinics, one urban and one rural. RESULTS We examine popular aetiological beliefs, ideas about biomedical treatment and its implications, and comparative views on the benefits and drawbacks of treatment in both public and private clinics. CONCLUSIONS We highlight two main themes. One was nostalgia for a recent past when 'pure' and 'natural' food, 'proper' meals and less stressful lives meant less chronic illness, with demanding and costly treatment. The other concerned communication in the clinic, and the recurrent dismay patients felt at what they saw as the cursory attention and guidance they received from clinic staff in public facilities.
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Cois A, Ehrlich R. Analysing the socioeconomic determinants of hypertension in South Africa: a structural equation modelling approach. BMC Public Health 2014; 14:414. [PMID: 24885860 PMCID: PMC4021547 DOI: 10.1186/1471-2458-14-414] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 04/22/2014] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Epidemiological research has long observed a varying prevalence of hypertension across socioeconomic strata. However, patterns of association and underlying causal mechanisms are poorly understood in sub-Saharan Africa. Using education and income as indicators, we investigated the extent to which socioeconomic status is linked to blood pressure in the first wave of the National Income Dynamics Study--a South African longitudinal study of more than 15,000 adults--and whether bio-behavioural risk factors mediate the association. METHODS In a cross-sectional analysis, structural equation modelling was employed to estimate the effect of socioeconomic status on systolic and diastolic blood pressure and to assess the role of a set of bio-behavioural risk factors in explaining the observed relationships. RESULTS After adjustment for age, race and antihypertensive treatment, higher education and income were independently associated with higher diastolic blood pressure in men. In women higher education predicted lower values of both diastolic and systolic blood pressure while higher income predicted lower systolic blood pressure. In both genders, body mass index was a strong mediator of an adverse indirect effect of socioeconomic status on blood pressure. Together with physical exercise, alcohol use, smoking and resting heart rate, body mass index therefore contributed substantially to mediation of the observed relationships in men. By contrast, in women unmeasured factors played a greater role. CONCLUSION In countries undergoing epidemiological transition, effects of socioeconomic status on blood pressure may vary by gender. In women, factors other than those listed above may have substantial role in mediating the association and merit investigation.
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Affiliation(s)
- Annibale Cois
- School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa
| | - Rodney Ehrlich
- School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa
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Bastawrous A, Mathenge W, Peto T, Weiss HA, Rono H, Foster A, Burton M, Kuper H. The Nakuru eye disease cohort study: methodology & rationale. BMC Ophthalmol 2014; 14:60. [PMID: 24886366 PMCID: PMC4024270 DOI: 10.1186/1471-2415-14-60] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 04/03/2014] [Indexed: 11/22/2022] Open
Abstract
Background No longitudinal data from population-based studies of eye disease in sub-Saharan-Africa are available. A population-based survey was undertaken in 2007/08 to estimate the prevalence and determinants of blindness and low vision in Nakuru district, Kenya. This survey formed the baseline to a six-year prospective cohort study to estimate the incidence and progression of eye disease in this population. Methods/Design A nationally representative sample of persons aged 50 years and above were selected between January 2007 and November 2008 through probability proportionate to size sampling of clusters, with sampling of individuals within clusters through compact segment sampling. Selected participants underwent detailed ophthalmic examinations which included: visual acuity, autorefraction, visual fields, slit lamp assessment of the anterior and posterior segments, lens grading and fundus photography. In addition, anthropometric measures were taken and risk factors were assessed through structured interviews. Six years later (2013/2014) all subjects were invited for follow-up assessment, repeating the baseline examination methodology. Discussion The methodology will provide estimates of the progression of eye diseases and incidence of blindness, visual impairment, and eye diseases in an adult Kenyan population.
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Affiliation(s)
- Andrew Bastawrous
- International Centre for Eye Health, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London WC1E 7HT, UK.
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Wang Z, Yue X, Wang H, Bao C, Xu W, Chen L, Qi X. Relation of socioeconomic status to hypertension occurrence. Int J Cardiol 2014; 173:544-5. [PMID: 24685000 DOI: 10.1016/j.ijcard.2014.03.082] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 03/12/2014] [Indexed: 11/20/2022]
Affiliation(s)
- Zhida Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China; 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, the Key Laboratory of Hormones and Development (Ministry of Health), Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Xiaofei Yue
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Huili Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | | | - Weili Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, Stockholm, Sweden
| | - Liming Chen
- 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, the Key Laboratory of Hormones and Development (Ministry of Health), Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Xiuying Qi
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.
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Yip JLY, Luben R, Hayat S, Khawaja AP, Broadway DC, Wareham N, Khaw KT, Foster PJ. Area deprivation, individual socioeconomic status and low vision in the EPIC-Norfolk Eye Study. J Epidemiol Community Health 2013; 68:204-10. [PMID: 24179053 PMCID: PMC4157999 DOI: 10.1136/jech-2013-203265] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Poor vision is associated with lower socioeconomic status, but less is known about its relationship to area deprivation. Methods The European Prospective Investigation into Cancer and Nutrition study Norfolk Eye Study was a cross-sectional study of 8563 participants with completed eye examinations. Logarithm of the minimum angle of resolution (logMAR) visual acuity (VA) was measured using standard protocols and low vision (LV) was defined as Snellen equivalent (VA) ≤6/12 in the better eye. Uncorrected refractive error (URE) was defined as improvement of VA by 2 logarithm of the minimum angle of resolution lines with pinhole. The lowest 5% of index of multiple deprivation rank was used to define the most deprived areas. The index of multiple deprivation is a composite measure using routine data from seven domains of deprivation to identify the most disadvantaged areas in England. Logistic regression was used to examine univariable and multivariable associations with LV. Results Ninety-six participants with missing data were excluded, leaving 8467 for analysis (98.9%). The mean age of the study group was 68.7 years (SD=8.1, range=48–92), with 55.1% women. LV was present in 263 participants (3.1%, 95% CI 2.7 to 3.5%). LV was associated with deprivation after adjusting for age, sex, education, social class and cataract surgery (OR=1.7, 95% CI 1.1 to 2.6, p=0.03), but this effect was mitigated by additionally adjusting for URE (OR=1.5, 95% CI 1.0 to 2.4, p=0.09). Conclusions People with LV are more likely to live in the most deprived areas; this association was independent of socioeconomic status and partly mediated by URE. Targeting URE in deprived areas may reduce health inequalities associated with LV.
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Affiliation(s)
- Jennifer L Y Yip
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, , Cambridge, UK
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Kengne AP, Echouffo-Tcheugui JB, Sobngwi E, Mbanya JC. New insights on diabetes mellitus and obesity in Africa-part 1: prevalence, pathogenesis and comorbidities. Heart 2013; 99:979-83. [PMID: 23680891 DOI: 10.1136/heartjnl-2012-303316] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Evidence continues to accumulate on the rising burden of diabetes mellitus at a higher pace in Africa. In a series of two papers, we sought to summarise recent evidence on diabetes and obesity in Africa based on a systematic review of studies published between January 2002 and October 2012. This first paper on the prevalence, pathogenesis and comorbidities shows that the increase in diabetes prevalence has paralleled that of obesity in Africa. Recent surveys on diabetes and obesity have been largely suboptimal. Hence, the need for more representative and robust continent-wide prevalence figures, which may be somehow achieved through pooling of existing data. Prospective studies linking environmental risk factors to disease occurrence and outcomes remain scarce, and genetic factors for diabetes or obesity have not been extensively assessed. The health consequences of diabetes are manifold, and include a complex interaction with other conditions like HIV infection and sickle cell disease/trait.
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