SP1-112 Prevalence of hypertension among Bangladeshi adult population: a meta-analysis

Residential area greenness and hypertension: a national assessment on urban adults in Bangladesh

This study investigated the associations between greenness and blood pressure (BP) metrics (systolic BP [SBP], diastolic BP [DBP], hypertension) among urban adults in Bangladesh and the potential mediation effects of body mass index (BMI) using 2011 Bangladesh Demographic and Health Survey data for 2360 urban adults (aged ≥35 years). The Enhanced Vegetation Index was used as a measure of residential area greenness. Associations between greenness and BP metrics were estimated using linear and binary logistic regression models. We also conducted mediation analyses. Greater area-level greenness was inversely associated with SBP (β -1.33, 95%CI: -2.46, -.20), DBP (β -.83, 95%CI: -1.64, -.02), and hypertension (adjusted odds ratio .87, 95%CI: .77, .98). BMI substantially mediated associations between greenness and BP metrics. Adopting urban greening policies could reduce the risk of hypertension, thus can contribute to reduction of non-communicable disease burden in Bangladesh. Longitudinal studies are required to further investigate the causal pathways.

Exploring socio-demographic-and geographical-variations in prevalence of diabetes and hypertension in Bangladesh: Bayesian spatial analysis of national health survey data

Bangladesh has been experiencing an epidemiological transition from communicable diseases to non-communicable disease (NCDs), with a rapid increase in the NCD related morbidity and mortality in the last decade. Hypertension and diabetes are two important risk factors of NCDs that significantly increase the burden of cardiovascular diseases and risk of death. While the prevalence of people with both hypertension and diabetes has been increasing dramatically over time, it is essential to identify relatively more prevalent socio-demographic groups and geographical regions (local administrative districts) to reduce the NCDs related deaths in an urgent basis. This study focused on examining the association of socio-demographic factors with both hypertension and diabetes and exploring the regional variations in their prevalence using nationally representative survey data on adult population of age over 35 years. Bayesian spatial analysis was performed for both hypertension and diabetes data separately by fitting a model, that accounts for spatial variations, using integrated nested laplace approximation. The area-specific prevalence was then estimated as weighted average of the corresponding individual level predicted probabilities of being diseased derived from the fitted model, with weight from the individual level sampling weight. Finally, the estimated area-specific prevalence estimates were sketched in country-map to explore regional variations and identify regions with relatively higher prevalence. The results revealed that people of older age, higher education, better socio-economic condition, higher BMI are at greater risk of having hypertension and diabetes. Significant regional variations were observed with prevalence for hypertension ranges between 10% and 35% and for diabetes between 6% and 19% while their national prevalence were reported as 24% and 11%, respectively. The western regions of the country including middle capital city were found to be relatively more prevalent for hypertension while the middle-east and south-east regions were observed to be more prevalent for diabetes. The capital Dhaka region was observed as the most prevalent for both diabetes and hypertension. Details explanations of the findings and evidence based policy implications were discussed.

Prevalence and determinants of hypertension in Myanmar - a nationwide cross-sectional study

BACKGROUND

Non-communicable diseases (NCDs), malaria and tuberculosis dominate the disease pattern in Myanmar. Due to urbanization, westernized lifestyle and economic development, it is likely that NCDs such as cerebrovascular disease and ischemic heart disease are on a rise. The leading behavioral- and metabolic NCDs risk factors are tobacco smoke, dietary risks and alcohol use, and high blood pressure and body mass index, respectively. The study aimed at estimating the prevalence and determinants of hypertension, including metabolic-, behavioral- and socio-demographic risk factors.

METHODS

A nationwide, cross-sectional study of 7429 citizens of Myanmar aged 15-64 years were examined in 2009, using the WHO STEPS methodology. In separate analyses by gender, odds radios (ORs) and 95 % confidence intervals (CIs) for determinants of hypertension were estimated using logistic regression analyses. Confounders included in analyses were chosen based on Directed acyclic graphs (DAGs).

RESULTS

The prevalence of hypertension was 30.1 % (95 % CI: 28.4-31.8) in males and 29.8 % (28.5-31.1) in females. The mean BMI was 21.7 (SD 4.3) kg/m(2) for males and 23.0 (5.1) kg/m(2) for females. In fully adjusted analyses, we found in both genders increased OR for hypertension if the participants had high BMI (males: OR = 2.6; 95 % CI 2.1-3.3, females: OR = 2.3; 2.0-2.7) and high waist circumference (males: OR = 3.4; 1.8-6.8, females: OR = 2.7; 2.2-3.3). In both sexes, associations were also found between hypertension and low physical activity at work, or living in urban areas or the delta region. Being underweight and use of sesame oil in cooking was associated with lower odds for hypertension.

CONCLUSIONS

The prevalence of hypertension was high and associated with metabolic-, behavioral- and socio-demographic factors. Due to expected rapid economic growth in Myanmar we recommend similar studies in the future to follow up and describe trends in the risk factors, especially modifiable factors, which will most likely be on rise. Studies on effectiveness on interventions are needed, and policies to reduce the burden of NCD risk factors should be implemented if proven effective in similar settings.