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Zayar NN, Chotipanvithayakul R, Bjertness E, Htet AS, Geater AF, Chongsuvivatwong V. Vulnerability of NCDs and Mediating Effect of Risk Behaviors Among Tuberculosis Patients and Their Household Contacts Compared to the General Population in the Yangon Region, Myanmar. Int J Gen Med 2023; 16:5909-5920. [PMID: 38106977 PMCID: PMC10725691 DOI: 10.2147/ijgm.s439141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose We investigated the association of TB patients and their household contacts with diabetes mellitus (DM) and hypertension compared to the general population, and the mediating effects of risk behaviors including current smoking, alcohol drinking, and poor diet quality. Patients and Methods A cross-sectional study on screening for DM, hypertension, and risk behaviors among newly diagnosed TB patients (n = 221) and their household contacts (n = 257) aged 25-74 years in Yangon in 2018. Health data of the general population (n = 755) were obtained from an NCD risk factor survey in Yangon. A directed acyclic graph is used to identify possible pathways of association between variables. Associations are presented as adjusted odds ratios (aOR). Results Compared to the general population, both TB patients and their household contacts were associated with current smoking and drinking, and TB patients were more likely to be underweight. Without considering mediating effects, TB patients had higher odds of DM (aOR = 6.3, 95% CI: 3.8-10.6), but both TB patients and household contacts had lower odds of hypertension (aOR = 0.54; 95% CI: 0.33-0.87) and (aOR = 0.68; 95% CI: 0.47-0.98), respectively. The body mass index-mediated pathway reduced the odds of DM and hypertension among TB patients (aOR = 3.4; 95% CI: 2.2-5.3) and (aOR = 0.3; 95% CI: 0.2-0.5), respectively. Conclusion The shared risk behaviors among TB patients and household contacts with high burden of DM in TB patients endorse screening of risk behaviors and strengthening the integration of NCD services among TB patients and household contacts in this dual-burden country.
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Affiliation(s)
- Nyi Nyi Zayar
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Rassamee Chotipanvithayakul
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Espen Bjertness
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Aung Soe Htet
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Alan Frederick Geater
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Virasakdi Chongsuvivatwong
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
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Pardoel ZE, Lensink R, Postma M, Win HH, Swe KH, Stein C, Febrinasari R, My Hanh H, Koot JA, Landsman JA, Reijneveld SA. Knowledge on hypertension in Myanmar: levels and groups at risk. OPEN RESEARCH EUROPE 2023; 2:13. [PMID: 37645316 PMCID: PMC10445853 DOI: 10.12688/openreseurope.14415.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 08/31/2023]
Abstract
Background: Non-communicable diseases, specifically the burden of hypertension, have become a major public health threat to low- and middle-income countries, such as Myanmar. Inadequate knowledge of hypertension and its management among people may hinder its effective prevention and treatment with some groups at particular increased risks, but evidence on this is lacking for Myanmar. The aims of this study were therefore to assess the level of knowledge of risk factors, symptoms and complications of hypertension, by hypertension treatment status, community group-membership, and sociodemographic and socioeconomic factors in Myanmar. Methods: Data was collected through structured questionnaires in 2020 on a random sample of 660 participants, stratified by region and existence of community groups. Knowledge of hypertension was measured with the 'Knowledge' part of a validated 'Knowledge, Attitude and Practice' survey questionnaire and categorised into ill-informed and reasonably to well-informed about hypertension. Results: The majority of respondents seem reasonably to well-informed about risk factors, symptoms and complications of hypertension. This did not vary by hypertension treatment status and community group membership. People with jobs (B=0.96; 95%-confidence interval 0.343 to 1.572) and higher education (B=1.96; 0.060 to 3.868) had more hypertension knowledge than people without jobs or low education. Adherence to treatment among hypertensive people was low. Conclusion: This study shows a majority of participants in this study in Myanmar seem reasonably to well-informed, with no differences by hypertension status, treatment status, and community group-membership. People without jobs and low education have less hypertension knowledge, making them priority groups for tailored education on health care level as well as community level, lowering the burden of hypertension. Almost half of the hypertensive patients did not take their medicines and therefore, adherence to treatment of hypertension should be an important element for future health education.
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Affiliation(s)
- Zinzi E. Pardoel
- Health Sciences, University Medical Center Groningen, Groningen, Groningen, 9700 RB, The Netherlands
| | - Robert Lensink
- Faculty of Economics and Business, University of Groningen, Groningen, Groningen, The Netherlands
| | - Maarten Postma
- Health Sciences, University Medical Center Groningen, Groningen, Groningen, 9700 RB, The Netherlands
- Faculty of Economics and Business, University of Groningen, Groningen, Groningen, The Netherlands
| | - Hla Hla Win
- University of Public Health, Yangon, Myanmar
| | | | | | - Ratih Febrinasari
- Department of Pharmacology, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Hoang My Hanh
- Health Strategy and Policy Institute, Hanoi, Vietnam
| | - Jaap A.R. Koot
- Health Sciences, University Medical Center Groningen, Groningen, Groningen, 9700 RB, The Netherlands
| | - Johanna A. Landsman
- Health Sciences, University Medical Center Groningen, Groningen, Groningen, 9700 RB, The Netherlands
| | - Sijmen A. Reijneveld
- Health Sciences, University Medical Center Groningen, Groningen, Groningen, 9700 RB, The Netherlands
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3
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Haung Z, Hong SA. Prevalence and factors associated with treatment and control of hypertension among adults with hypertension in Myanmar. Int Health 2023; 15:207-215. [PMID: 35851920 PMCID: PMC9977219 DOI: 10.1093/inthealth/ihac047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 05/03/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Due to a dearth in the number of studies conducted in low- and middle-income countries, this study aimed to identify the prevalence and determinants of the treatment and control of hypertension among patients with hypertension in Myanmar. METHODS This community-based cross-sectional study was conducted among 410 adults who were registered for hypertensive treatment in health centers in Myitkyina Township, Kachin State, Myanmar. Multiple logistic regression was used to identify the associated factors. RESULTS The prevalence of treatment and control of hypertension was 48.1% and 20.5%, respectively. The factors associated with treatment were age (OR=2.60 for 46-60 y and OR=2.29 for 61-70 y compared with 30-45 y), ethnicity (OR=1.87), monthly family income (OR=1.90), comorbidity (OR=2.33), knowledge (OR=2.63) and adherence to physical activity (OR=1.86). Controlled hypertension was associated with age (OR=3.03 for 46-60 y and OR=2.27 for 61-70 y compared with 30-45 y), education (OR=1.81), comorbidity (OR=1.67) and adherence to medication (OR=3.45). CONCLUSIONS The prevalence of treated and controlled hypertension was relatively low in this study. To improve the prevalence of hypertension treatment and control in this study population, effective and culturally sensitive intervention programs under universal health coverage should be established with an emphasis on individuals with lower educational attainment and younger ages.
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Affiliation(s)
- Ze Haung
- Township Department of Public Health, Myitkyina Township, Kachin State, Myanmar
| | - Seo Ah Hong
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phuthamonthon, Nakhon Pathom 73170, Thailand
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Nozaki I, Shobugawa Y, Sasaki Y, Takagi D, Nagamine Y, Zin PE, Bo TZ, Nyunt TW, Oo MZ, Lwin KT, Win HH. Unmet needs for hypertension diagnosis among older adults in Myanmar: secondary analysis of a multistage sampling study. Health Res Policy Syst 2022; 20:114. [DOI: 10.1186/s12961-022-00918-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/16/2022] [Indexed: 11/30/2022] Open
Abstract
Abstract
Background
Hypertension is a major cause of morbidity among older adults. We investigated older adults’ access to health services in Myanmar by focusing on unmet needs in diagnosing hypertension. This study aims to identify factors associated with the unmet needs for hypertension diagnosis in the study areas of Myanmar.
Methods
This is a secondary data analysis of the survey which is a cross-sectional study conducted with older adults (aged ≥ 60 years) in the Yangon and Bago regions of Myanmar. Objective indicators of health were collected, including blood pressure, height and weight. The diagnosis of hypertension was considered an unmet need when a participant’s blood pressure measurement met the diagnostic criteria for hypertension but the disease had not yet been diagnosed. Bivariate and multivariate analyses using logistic regression were performed to identify factors associated with the unmet need for hypertension diagnosis. Factors related to lifestyle habits and medical-seeking behaviour were selected and put into the multivariate model.
Results
Data from 1200 people, 600 from each of the two regions, were analysed. Altogether 483 (40.3%) participants were male, 530 (44.2%) were aged ≥ 70 years, and 857 were diagnosed with hypertension based on their measured blood pressure or diagnostic history, or both, which is a 71.4% prevalence of hypertension. Moreover, 240 (20.0%) participants had never been diagnosed with hypertension. In the multivariate analysis, these unmet needs for hypertension diagnosis were significantly associated with male sex (odds ratio [OR] 1.46, 95% confidence interval [CI] 1.05–2.05), residence in the Bago region (OR 1.64, 95% CI 1.09–2.45) and better self-rated health (OR 1.70, 95% CI 1.24–2.33), but not with education, category on the wealth index or living arrangement.
Conclusions
There are barriers to accessing health services for hypertension diagnosis, as evidenced by the regional disparities found in this study, and charitable clinics may decrease the financial barrier to this diagnosis.
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Bhatia M, Kumar M, Dixit P, Dwivedi LK. Diagnosis and Treatment of Hypertension Among People Aged 45 Years and Over in India: A Sub-national Analysis of the Variation in Performance of Indian States. Front Public Health 2021; 9:766458. [PMID: 34778193 PMCID: PMC8585934 DOI: 10.3389/fpubh.2021.766458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Cardiovascular disease (CVD) is the single largest contributor to non-communicable disease (NCD) deaths, with hypertension contributing to a significant proportion of these deaths. This study aims to provide estimates of the prevalence, awareness, treatment and control of hypertension at sub-national levels in India and identifies well and under-performing states with respect to the diagnosis and treatment of hypertension. Methods: The study utilises data from the Longitudinal Study of Ageing in India (LASI), a nationally representative survey of more than 72,000 individuals. Age-sex adjusted prevalence rates of self-reported hypertension was calculated using the direct standardisation method. Multivariable logistic regression was performed to assess the association of self-reported hypertension with the various individual co-morbidity, lifestyle, and household factors. Self-reported prevalence was compared with an objective measure of hypertension for each state, and funnel plots were constructed to assess the performance of states. Results: Our findings suggest that the overall prevalence of age-sex adjusted self-reported hypertension was 25.8% in India with significant variation among states. Results based on logistic regression confirm that those individuals who are elderly, obese, belong to a higher socio-economic group and have associated co-morbidities are at increased odds of reporting hypertension. Overall, 4 out of 10 adults over 45 years of age in India are not aware of their hypertensive condition, and of those who are aware, 73% are currently taking medication, and only 10% of these have their hypertension under control. Based on the performance, states were classified into high and low performing categories. States with an increased proportion of population below the poverty line had significantly lower performance with respect to the diagnosis of hypertension, whereas states with higher literacy rates and greater availability of specialist doctors at community health centres (CHCs) had significantly better performance with respect to treatment-seeking behaviour. Conclusion: The findings of this study and its policy implications are discussed. Based on state performance, strategies are proposed in terms selective targeting vs. population-based strategies. High impact states and sub-groups are identified where intense efforts are needed to tackle the growing menace of hypertension in India.
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Affiliation(s)
- Mrigesh Bhatia
- Department of Health Policy, London School of Economics, London, United Kingdom
| | - Manish Kumar
- Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Mumbai, India
| | - Priyanka Dixit
- School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India
| | - Laxmi Kant Dwivedi
- Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Mumbai, India
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Soitong P, Jangjaicharoen S, Kaewsanit A, Mali P, Viriyakhaikul Y, Boonnumma S, Tipmabutr S, Chalermchuang P, Maneechot W, Numnoi C, Phungmali K, Meksong T, Ponpadermyod B, Jirachairattanasin W, Sakboonyarat B, Rangsin R, Mungthin M, Piyaraj P. Association of neck circumference and hypertension among adults in a rural community Thailand: A cross-sectional study. PLoS One 2021; 16:e0256260. [PMID: 34415934 PMCID: PMC8378687 DOI: 10.1371/journal.pone.0256260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/04/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Hypertension (HT) is a major non-communicable disease worldwide and a growing global public health problem. Although several studies have investigated the independent associations of neck circumference (NC) and hypertension, no such studies have been conducted among the Thai population. Aim This study aims to identify risk factors associated with hypertension, which may be used to predict HT among asymptomatic adults residing in a remote rural community in central Thailand. Method 1,084 adults were included in this community-based cross-sectional study by a population-based total survey. The participants were included those who had been living in 6 villages in the rural community in the central area of Thailand. Anthropometric information, NC, body composition indexes such as waist circumference and blood pressure were measured. Logistic regression models were fitted to calculate the multi-variable adjusted prevalence and the association of NC with HT. Result The prevalence of HT among adults in the rural community was 27.7% (95% CI: 25.0–30.3). Of the 300 adults with HT, 164 participants (54.7%) were found within the unawareness HT category. We found that associated factors with HT were included larger neck circumference both continuous and categorical (≥ 37.5 in male, ≥ 32.5 in female), pre-existing diabetes mellitus, male, and higher body mass index. Conclusion Almost one-third of participants in the remote rural areas presented hypertension. NC was associated with HT independent from other risk factors. NC is a simple and useful anthropometric index to identify HT in rural Thai adults.
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Affiliation(s)
- Panuwat Soitong
- Fourth Year Medical Cadet, Phramongkutklao College of Medicine, Bangkok, Thailand
| | | | - Apisit Kaewsanit
- Fourth Year Medical Cadet, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Parinya Mali
- Fourth Year Medical Cadet, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Yada Viriyakhaikul
- Fourth Year Medical Cadet, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Supakarn Boonnumma
- Fourth Year Medical Cadet, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Suphat Tipmabutr
- Fourth Year Medical Cadet, Phramongkutklao College of Medicine, Bangkok, Thailand
| | | | - Warunporn Maneechot
- Fourth Year Medical Cadet, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Chanunchida Numnoi
- Fourth Year Medical Cadet, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Kitwiwat Phungmali
- Fourth Year Medical Cadet, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Thana Meksong
- Fourth Year Medical Cadet, Phramongkutklao College of Medicine, Bangkok, Thailand
| | | | | | - Boonsub Sakboonyarat
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Ram Rangsin
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Mathirut Mungthin
- Department of Pharmacology, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Phunlerd Piyaraj
- Department of Parasitology, Phramongkutklao College of Medicine, Bangkok, Thailand
- * E-mail:
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Fan LM, Wang F, Zhao M, Cui WL, Cai L. Socioeconomic differentials in trends in the prevalence of hypertension and pre-hypertension and hypertension awareness, treatment, and control in rural Southwestern China. BMC Cardiovasc Disord 2021; 21:259. [PMID: 34039284 PMCID: PMC8157672 DOI: 10.1186/s12872-021-02062-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 05/14/2021] [Indexed: 01/23/2023] Open
Abstract
Background This study examines the socioeconomic differentials in trends in the prevalence of hypertension and pre-hypertension and hypertension awareness, treatment, and control in rural Southwestern China. Methods Two cross-sectional interviews and health examination surveys were administered in rural Yunnan Province, including 6,350 consenting participants in 2009 and 6,359 consenting participants in 2016 (aged ≥ 35 years). Participant demographics, socioeconomic status (SES), and ethnicity, along with information about hypertension awareness, treatment, and control, were collected using similar questionnaires in the two surveys. The participants’ blood pressure levels were also measured. Results From 2009 to 2016, the prevalence of hypertension substantially increased from 28.4% to 39.5% (P < 0.01), and awareness and control rose from 42.2 and 25.8% to 53.1 (P < 0.01) and 30.6% (P < 0.05), respectively. Although people with a higher education level also had higher awareness and control rates than the lower education level ones, there were no conspicuous differences in the improvement of awareness and control between publics with different education levels over the 7 years studied. Increases were observed in both rates of awareness and control in people with a high level of income (P < 0.01). However, only the awareness rate increased in participants with a low level of income. Furthermore, the prevalence (P < 0.01) and treatment (P < 0.05) of hypertension were higher in the Han people than in ethnic minorities. Conclusions Individual SES has clear associations with trends in the prevalence, awareness, and control of hypertension. Future interventions to improve hypertension prevention and control should be tailored to address individual SES.
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Affiliation(s)
- Lu-Ming Fan
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Cheng Gong New City, 650500, Kunming, China
| | - Fang Wang
- Department of Science and Technology, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Cheng Gong New City, 650500, Kunming, China
| | - Min Zhao
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Cheng Gong New City, 650500, Kunming, China
| | - Wen-Long Cui
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Cheng Gong New City, 650500, Kunming, China
| | - Le Cai
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Cheng Gong New City, 650500, Kunming, China.
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The Prevalence and Risk Factors of Hypertension among the Urban Population in Southeast Asian Countries: A Systematic Review and Meta-Analysis. Int J Hypertens 2021; 2021:6657003. [PMID: 33628485 PMCID: PMC7889387 DOI: 10.1155/2021/6657003] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/07/2021] [Accepted: 01/25/2021] [Indexed: 12/18/2022] Open
Abstract
The trend of global prevalence for hypertension has been dramatically increasing for the past two decades in Southeast Asian countries. A systematic review aiming to assess the prevalence of hypertension and its risk factors among the urban population in Southeast Asian countries was conducted. We performed database searches of PubMed and Web of Science and performed meta-analysis to determine the pooled prevalence estimate. The overall pooled prevalence estimate of hypertension for Southeast Asian urban population was 33.82%. Among this, 33.98% of hypertension was reported in the community and 32.45% among adolescents in school. The common risk factors that we found were male, ethnicity, education and socioeconomic level, body mass index, waist circumference, smoking, and dyslipidaemia. The review indicates an urgent need for primary and secondary prevention activities. Therefore, a multisectoral and intersectoral approach and collaboration should be undertaken to improve the overall health outcomes of all populations in all Southeast Asian countries.
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Filippatos G, Angermann CE, Cleland JGF, Lam CSP, Dahlström U, Dickstein K, Ertl G, Hassanein M, Hart KW, Lindsell CJ, Perrone SV, Guerin T, Ghadanfar M, Schweizer A, Obergfell A, Collins SP. Global Differences in Characteristics, Precipitants, and Initial Management of Patients Presenting With Acute Heart Failure. JAMA Cardiol 2021; 5:401-410. [PMID: 31913404 DOI: 10.1001/jamacardio.2019.5108] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Acute heart failure (AHF) precipitates millions of hospital admissions worldwide, but previous registries have been country or region specific. Objective To conduct a prospective contemporaneous comparison of AHF presentations, etiologic factors and precipitants, treatments, and in-hospital outcomes among global regions through the International Registry to Assess Medical Practice with Longitudinal Observation for Treatment of Heart Failure (REPORT-HF). Design, Setting, and Participants A total of 18 553 adults were enrolled during a hospitalization for AHF. Patients were recruited from the acute setting in Western Europe (WE), Eastern Europe (EE), Eastern Mediterranean and Africa (EMA), Southeast Asia (SEA), Western Pacific (WP), North America (NA), and Central and South America (CSA). Patients with AHF were approached for consent and excluded only if there was recent participation in a clinical trial. Patients were enrolled from July 23, 2014, to March 24, 2017. Statistical analysis was conducted from April 18 to June 29, 2018; revised analyses occurred between August 6 and 29, 2019. Main Outcomes and Measures Heart failure etiologic factors and precipitants, treatments, and in-hospital outcomes among global regions. Results A total of 18 553 patients were enrolled at 358 sites in 44 countries. The median age was 67.0 years (interquartile range [IQR], 57-77), 11 372 were men (61.3%), 9656 were white (52.0%), 5738 were Asian (30.9%), and 867 were black (4.7%). A history of HF was present in more than 50% of the patients and 40% were known to have a prior left-ventricular ejection fraction lower than 40%. Ischemia was a common AHF precipitant in SEA (596 of 2329 [25.6%]), WP (572 of 3354 [17.1%]), and EMA (364 of 2241 [16.2%]), whereas nonadherence to diet and medications was most common in NA (306 of 1592 [19.2%]). Median time to the first intravenous therapy was 3.0 (IQR, 1.4-5.6) hours in NA; no other region had a median time above 1.2 hours (P < .001). This treatment delay remained after adjusting for severity of illness (P < .001). Intravenous loop diuretics were the most common medication administered in the first 6 hours of AHF management across all regions (65.4%-89.9%). Despite similar initial blood pressure across all regions, inotropic agents were used approximately 3 times more often in SEA, WP, and EE (11.3%-13.5%) compared with NA and WE (3.1%-4.3%) (P < .001). Older age (odds ratio [OR], 1.0; 95% CI, 1.00-1.02), HF etiology (ischemia: OR, 1.65; 95% CI, 1.11-2.44; valvular: OR, 2.10; 95% CI, 1.36-3.25), creatinine level greater than 2.75 mg/dL (OR, 1.85; 95% CI, 0.71-2.40), and chest radiograph signs of congestion (OR, 2.03; 95% CI, 1.39-2.97) were all associated with increased in-hospital mortality. Similarly, younger age (OR, -0.04; 95% CI, -0.05 to -0.02), HF etiology (ischemia: OR, 0.77; 95% CI, 0.26-1.29; valvular: OR, 2.01; 95% CI, 1.38-2.65), creatinine level greater than 2.75 mg/dL (OR, 1.16; 95% CI, 0.31-2.00), and chest radiograph signs of congestion (OR, 1.02; 95% CI, 0.57-1.47) were all associated with increased in-hospital LOS. Conclusions and Relevance Data from REPORT-HF suggest that patients are similar across regions in many respects, but important differences in timing and type of treatment exist, identifying region-specific gaps in medical management that may be associated with patient outcomes.
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Affiliation(s)
- Gerasimos Filippatos
- University of Cyprus School of Medicine, Cyprus, Greece.,Attikon University Hospital, Department of Cardiology, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Christiane E Angermann
- Comprehensive Heart Failure Center, University Hospital, Department of Medicine I-Cardiology, University of Würzburg, Würzburg, Germany
| | - John G F Cleland
- Robertson Centre for Biostatistics and Clinical Trials, Institute of Health & Well-Being, University of Glasgow, Glasgow, United Kingdom.,National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore.,Cardiovascular Academic Clinical Program, Duke-National University of Singapore, Singapore.,Department of Cardiology, University Medical Centre Groningen, Groningen, the Netherlands
| | - Ulf Dahlström
- Department of Cardiology, Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden
| | | | - Georg Ertl
- Comprehensive Heart Failure Center, University Hospital, Department of Medicine I-Cardiology, University of Würzburg, Würzburg, Germany
| | - Mahmoud Hassanein
- Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Kimberly W Hart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Sergio V Perrone
- El Cruce Hospital by Florencio Varela, Lezica Cardiovascular Institute, Sanctuary of the Trinidad Miter, Buenos Aires, Argentina
| | | | | | | | | | - Sean P Collins
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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Trends in Diabetes Prevalence, Awareness, Treatment and Control in Yangon Region, Myanmar, Between 2004 and 2014, Two Cross-Sectional Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183461. [PMID: 31540348 PMCID: PMC6765960 DOI: 10.3390/ijerph16183461] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 09/06/2019] [Accepted: 09/13/2019] [Indexed: 01/04/2023]
Abstract
Myanmar is currently facing the burden of non-communicable diseases due to changes in lifestyle and dietary patterns linked to socio-economic development. However, evidence is scarce about changes in the prevalence of diabetes mellitus (DM) over time. We aimed to investigate changes in the prevalence, awareness, treatment and control of DM from 2004 to 2014, among adults aged 25–74 years, in the Yangon region. Two cross-sectional household-based studies, according to World Health Organization STEPwise approach to surveillance (WHO STEPS) methodology, were conducted in 2004 (n = 4448) and 2014 (n = 1372). The overall age-standardized prevalence of DM was 8.3% (95% CI 6.5–10.6) in 2004 and 10.2% (7.6–13.6) in 2014 (p = 0.296). The DM prevalence increased between the study years among elderly participants only, from 14.6% (11.7–18.1) to 31.9% (21.1–45.0) (p = 0.009). Awareness of having DM increased from 44.3% (39.2, 49.6) to 69.4% (62.9–75.2) (p < 0.001). Among participants who were aware of having DM, the proportion under treatment increased from 55.1% (46.8–63.1) to 68.6% (61.5–74.8) (p = 0.015). There was no change in proportion with controlled DM. Adjusted for age, sex and education, mean fasting plasma glucose levels in 2014 were 0.56 mmol/L (0.26–0.84) higher than in 2004. Preventive measures to halt future increases in DM prevalence and to increase the detection of undiagnosed DM cases are needed.
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Fatty Acid Profiles of Various Vegetable Oils and the Association between the Use of Palm Oil vs. Peanut Oil and Risk Factors for Non-Communicable Diseases in Yangon Region, Myanmar. Nutrients 2018; 10:nu10091193. [PMID: 30200403 PMCID: PMC6163161 DOI: 10.3390/nu10091193] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 02/07/2023] Open
Abstract
The majority of vegetable oils used in food preparation in Myanmar are imported and sold non-branded. Little is known about their fatty acid (FA) content. We aimed to investigate the FA composition of commonly used vegetable oils in the Yangon region, and the association between the use of palm oil vs. peanut oil and risk factors for non-communicable disease (NCD). A multistage cluster survey was conducted in 2016, and 128 oil samples from 114 households were collected. Data on NCD risk factors were obtained from a household-based survey in the same region, between 2013 and 2014. The oils most commonly sampled were non-branded peanut oil (43%) and non-branded palm oil (19%). Non-branded palm oil had a significantly higher content of saturated fatty acids (36.1 g/100 g) and a lower content of polyunsaturated fatty acids (9.3 g/100 g) than branded palm oil. No significant differences were observed regarding peanut oil. Among men, palm oil users had significantly lower mean fasting plasma glucose levels and mean BMI than peanut oil users. Among women, palm oil users had significantly higher mean diastolic blood pressure, and higher mean levels of total cholesterol and triglycerides, than peanut oil users. Regulation of the marketing of non-branded oils should be encouraged.
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Jiang M, Zha X, Wu Z, Zhu X, Li W, Wu H, Ma J, Wang S, Wen Y. Inverted U-shaped curve relationship between red blood cell distribution width and hypertension in a large health checkup population in China. ACTA ACUST UNITED AC 2018; 12:327-334. [PMID: 29606529 DOI: 10.1016/j.jash.2018.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 02/27/2018] [Accepted: 03/02/2018] [Indexed: 02/04/2023]
Abstract
This study was aimed at investigating the relationship between red blood cell distribution width (RDW) and hypertension in a large health check up population in China. A population of 302,527 subjects from Wuhu was enrolled in this cross-sectional health check up study between 2011 and 2016. They consisted of 126,369 women (41.78%) and 176,158 men (58.23%) with mean age of 46.9 ± 13.4 and 48.1 ± 13.7 years, respectively. The investigations included information on demographic characteristics, physical examination, and laboratory testing. Inverted U-shape relationships were observed between RDW and hypertension with peak RDW values of 14.2 (women) and 15.2 (men). After stratification by sex and adjusted with body mass index, age, white blood cells, and high-density lipoprotein cholesterol, inverted U-shape relationships were also established between RDW and hypertension, systolic blood pressure, and diastolic blood pressure, with peak RDW of 14.2, 14.5, 14.5 in women and 14.2, 16.0, 14.5 in men. Inverted U-shape relationship exists between RDW and hypertension, systolic blood pressure, and diastolic blood pressure among the Chinese health check up population studied.
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Affiliation(s)
- Mingfei Jiang
- School of Laboratory Medicine, Wannan Medical College, Wuhu City, Anhui Province, China
| | - Xiaojuan Zha
- First Affiliated Hospital, Wannan Medical College, Wuhu City, Anhui Province, China
| | - Zewei Wu
- School of Laboratory Medicine, Wannan Medical College, Wuhu City, Anhui Province, China
| | - Xinying Zhu
- School of Laboratory Medicine, Wannan Medical College, Wuhu City, Anhui Province, China
| | - Wenbo Li
- School of Clinical Medicine, Wannan Medical College, Wuhu City, Anhui Province, China
| | - Huan Wu
- School of Laboratory Medicine, Wannan Medical College, Wuhu City, Anhui Province, China
| | - Jun Ma
- School of Laboratory Medicine, Wannan Medical College, Wuhu City, Anhui Province, China
| | - Shuyi Wang
- School of Laboratory Medicine, Wannan Medical College, Wuhu City, Anhui Province, China
| | - Yufeng Wen
- School of Laboratory Medicine, Wannan Medical College, Wuhu City, Anhui Province, China.
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