The relationship between income, education and hypertension

A structured additive modeling of diabetes and hypertension in Northeast India

Background

Multiple factors are associated with the risk of diabetes and hypertension. In India, they vary widely even from one district to another. Therefore, strategies for controlling diabetes and hypertension should appropriately address local risk factors and take into account the specific causes of the prevalence of diabetes and hypertension at sub-population levels and in specific settings. This paper examines the demographic and socioeconomic risk factors as well as the spatial disparity of diabetes and hypertension among adults aged 15–49 years in Northeast India.

Methods

The study used data from the Indian Demographic Health Survey, which was conducted across the country between 2015 and 2016. All men and women between the ages of 15 and 49 years were tested for diabetes and hypertension as part of the survey. A Bayesian geo-additive model was used to determine the risk factors of diabetes and hypertension.

Results

The prevalence rates of diabetes and hypertension in Northeast India were, respectively, 6.38% and 16.21%. The prevalence was higher among males, urban residents, and those who were widowed/divorced/separated. The functional relationship between household wealth index and diabetes and hypertension was found to be an inverted U-shape. As the household wealth status increased, its effect on diabetes also increased. However, interestingly, the inverse was observed in the case of hypertension, that is, as the household wealth status increased, its effect on hypertension decreased. The unstructured spatial variation in diabetes was mainly due to the unobserved risk factors present within a district that were not related to the nearby districts, while for hypertension, the structured spatial variation was due to the unobserved factors that were related to the nearby districts.

Conclusion

Diabetes and hypertension control measures should consider both local and non-local factors that contribute to the spatial heterogeneity. More importance should be given to efforts aimed at evaluating district-specific factors in the prevalence of diabetes within a region.

Education achievement and type 2 diabetes-what mediates the relationship in older adults? Data from the ESTHER study: a population-based cohort study

OBJECTIVE

The study aims to identify the mediating factors of the relationship between education achievement and incident type 2 diabetes mellitus (T2DM) in older adults.

DESIGN

Population-based cohort study.

SETTING

Participants were recruited from the German federal state of Saarland.

PARTICIPANTS

Participants were excluded if they had prevalent T2DM or missing data on prevalent T2DM, missing or zero follow-up time for incident T2DM or were under 50 years of age. The total sample consisted of 7462 individuals aged 50-75 years (42.8% men, mean age 61.7 years) at baseline (2000-02). The median follow-up time was 8.0 years.

METHODS

Cox proportional hazards regression was initially used to determine the direct association between education achievement and incident T2DM. Using the Baron and Kenny approach, we then investigated the associations between education achievement and incident T2DM with the potential mediators. The contribution of each of the putative mediating variables was then calculated.

RESULTS

A clear socioeconomic gradient was observed with regard to T2DM incidence with the lowest educated individuals at a greater risk of developing the disease during the follow-up period: HR (95% CI) high education: 0.52 (0.34 to 0.80); medium education: 0.80 (0.66 to 0.96). Seven of the variables considered explained a proportion of the education-T2DM relationship (body mass index, alcohol consumption, hypertension, fasting triglycerides, high-density lipoprotein (HDL) cholesterol, physical activity and smoking status), where the contribution of the variables ranged from 1.0% to 17.7%. Overall, the mediators explained 31.7% of the relationship.

CONCLUSION

By identifying the possible mediating factors of the relationship between education achievement and incident T2DM in older adults, the results of this study can be used to assist with the development of public health strategies that aim to reduce socioeconomic inequalities in T2DM.

Genetic and nongenetic determinants of blood pressure in a southern Brazilian sample

A probabilistic sample representative of the adult population of Rio Grande do Sul, Brazil, was studied to estimate the genetic and nongenetic determinants of blood pressure. Four thousand five hundred and sixty-five individuals, 20 to 74 years old, from 2050 households, were examined. The genetic determination of the SBP (systolic blood pressure) and DBP (diastolic blood pressure) was evaluated in 557 families extracted from this sample. The analysis was performed first with no adjustments for other influencing factors, and then adjusting for the effects of the two significant covariates, age and Quetelet's index, identified through a multiple stepwise regression analysis with nine independent variables. Higher heritability estimates were obtained for DBP (raw data: 0.40; residuals: 0.45) than for SBP (raw data: 0.22; residuals: 0.26). The significant correlation coefficients varied from 0.13 (for father-offspring raw data, total sample), to 0.36 (for siblings, adjusted data, untreated sample). Slight differences were observed between the total and pharmacologically untreated samples in relation to correlation and heritability estimates.