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Zhou J, Sun W, Zhang C, Hou L, Luo Z, Jiang D, Tan B, Yuan C, Zhao D, Li J, Zhang R, Song P. Prevalence of childhood hypertension and associated factors in Zhejiang Province: a cross-sectional analysis based on random forest model and logistic regression. BMC Public Health 2024; 24:2101. [PMID: 39097727 PMCID: PMC11298091 DOI: 10.1186/s12889-024-19630-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 07/29/2024] [Indexed: 08/05/2024] Open
Abstract
With childhood hypertension emerging as a global public health concern, understanding its associated factors is crucial. This study investigated the prevalence and associated factors of hypertension among Chinese children. This cross-sectional investigation was conducted in Pinghu, Zhejiang province, involving 2,373 children aged 8-14 years from 12 schools. Anthropometric measurements were taken by trained staff. Blood pressure (BP) was measured in three separate occasions, with an interval of at least two weeks. Childhood hypertension was defined as systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) ≥ age-, sex-, and height-specific 95th percentile, across all three visits. A self-administered questionnaire was utilized to collect demographic, socioeconomic, health behavioral, and parental information at the first visit of BP measurement. Random forest (RF) and multivariable logistic regression model were used collectively to identify associated factors. Additionally, population attributable fractions (PAFs) were calculated. The prevalence of childhood hypertension was 5.0% (95% confidence interval [CI]: 4.1-5.9%). Children with body mass index (BMI) ≥ 85th percentile were grouped into abnormal weight, and those with waist circumference (WC) > 90th percentile were sorted into central obesity. Normal weight with central obesity (NWCO, adjusted odds ratio [aOR] = 5.04, 95% CI: 1.96-12.98), abnormal weight with no central obesity (AWNCO, aOR = 4.60, 95% CI: 2.57-8.21), and abnormal weight with central obesity (AWCO, aOR = 9.94, 95% CI: 6.06-16.32) were associated with an increased risk of childhood hypertension. Childhood hypertension was attributable to AWCO mostly (PAF: 0.64, 95% CI: 0.50-0.75), followed by AWNCO (PAF: 0.34, 95% CI: 0.19-0.51), and NWCO (PAF: 0.13, 95% CI: 0.03-0.30). Our results indicated that obesity phenotype is associated with childhood hypertension, and the role of weight management could serve as potential target for intervention.
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Affiliation(s)
- Jiali Zhou
- Department of Big Data in Health Science, School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310051, China
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, 310051, China
| | - Weidi Sun
- Department of Big Data in Health Science, School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310051, China
| | - Chenhao Zhang
- Department of Big Data in Health Science, School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310051, China
| | - Leying Hou
- Department of Big Data in Health Science, School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310051, China
| | - Zeyu Luo
- Department of Big Data in Health Science, School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310051, China
| | - Denan Jiang
- Department of Big Data in Health Science, School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310051, China
- The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, Zhejiang, 322000, China
| | - Boren Tan
- Department of Big Data in Health Science, School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310051, China
| | - Changzheng Yuan
- Department of Big Data in Health Science, School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310051, China
| | - Dong Zhao
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, 310051, China
| | - Juanjuan Li
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, 310051, China
| | - Ronghua Zhang
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, 310051, China.
| | - Peige Song
- Department of Big Data in Health Science, School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310051, China.
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Chauhan S, Kumar S, Patel R, Simon DJ, Kumari A. Burden of communicable and non-communicable diseases-related inequalities among older adults in India: a study based on LASI survey. BMC Geriatr 2022; 22:790. [PMID: 36217103 PMCID: PMC9552506 DOI: 10.1186/s12877-022-03481-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 09/26/2022] [Indexed: 12/02/2022] Open
Abstract
Background A rising proportion of elderly in India has infused notable challenges to the healthcare system, which is already underdeveloped. On one side, NCDs are increasing among the elderly in India; however, on the other side, CDs are also a cause of concern among the elderly in India. While controlling the outbreak of communicable diseases (CDs) remained a priority, non-communicable diseases (NCDs) are placing an unavoidable burden on the health and social security system. India, a developing nation in South Asia, has seen an unprecedented economic growth in the past few years; however, it struggled to fight the burden of communicable and non-communicable diseases. Therefore, this study aimed at examining the burden of CDs and NCDs among elderly in India. Methods Data from Longitudinal Ageing Study in India (LASI Wave-I, 2017–18) were drawn to conduct this study. The LASI is a large-scale nationwide scientific study of the health, economics, and social determinants and implications of India's aged population. The LASI is a nationally representative survey of 72,250 aged 45 and over from all Indian states and union territories. Response variables were the occurrence of CDs and NCDs. The bi-variate and binary logistic regression were used to predict the association between communicable and non-communicable diseases by various socio-demographic and health parameters. Furthermore, to understand the inequalities of communicable and non-communicable diseases in urban and rural areas, the Fairlie decomposition technique was used to predict the contribution toward rural–urban inequalities in CDs and NCDs. Results Prevalence of communicable diseases was higher among uneducated elderly than those with higher education (31.9% vs. 17.3%); however, the prevalence of non-communicable diseases was higher among those with higher education (67.4% vs. 47.1%) than uneducated elderly. The odds of NCDs were higher among female elderly (OR = 1.13; C.I. = 1–1.27) than their male counterparts. Similarly, the odds of CDs were lower among urban elderly (OR = 0.70; C.I. = 0.62–0.81) than rural elderly, and odds of NCDs were higher among urban elderly (OR = 1.85; C.I. = 1.62–2.10) than their rural counterparts. Results found that education (50%) contributes nearly half of the rural–urban inequality in the prevalence of CDs among the elderly. Education status and current working status were the two significant predictors of widening rural–urban inequality in the prevalence of NCDs among the elderly. Conclusion The burden of both CD and NCD among the elderly population requires immediate intervention. The needs of men and women and urban and rural elderly must be addressed through appropriate efforts. In a developing country like India, preventive measures, rather than curative measures of communicable diseases, will be cost-effective and helpful. Further, focusing on educational interventions among older adults might bring some required changes. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03481-x.
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Affiliation(s)
- Shekhar Chauhan
- Department of Family and Generations, International Institute for Population Sciences, Mumbai, India
| | - Shubham Kumar
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, India
| | - Ratna Patel
- Research Scholar, Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India.
| | - David Jean Simon
- Research Scholar, Paris 1 Pantheon Sorbonne University, Paris, France
| | - Aradhana Kumari
- Research Scholar, Jawaharlal Nehru University, New Delhi, India
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Ogunsakin RE, Ginindza TG. Bayesian Spatial Modeling of Diabetes and Hypertension: Results from the South Africa General Household Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158886. [PMID: 35897258 PMCID: PMC9331550 DOI: 10.3390/ijerph19158886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/04/2022] [Accepted: 07/18/2022] [Indexed: 02/06/2023]
Abstract
Determining spatial links between disease risk and socio-demographic characteristics is vital in disease management and policymaking. However, data are subject to complexities caused by heterogeneity across host classes and space epidemic processes. This study aims to implement a spatially varying coefficient (SVC) model to account for non-stationarity in the effect of covariates. Using the South Africa general household survey, we study the provincial variation of people living with diabetes and hypertension risk through the SVC model. The people living with diabetes and hypertension risk are modeled using a logistic model that includes spatially unstructured and spatially structured random effects. Spatial smoothness priors for the spatially structured component are employed in modeling, namely, a Gaussian Markov random field (GMRF), a second-order random walk (RW2), and a conditional autoregressive (CAR) model. The SVC model is used to relax the stationarity assumption in which non-linear effects of age are captured through the RW2 and allow the mean effect to vary spatially using a CAR model. Results highlight a non-linear relationship between age and people living with diabetes and hypertension. The SVC models outperform the stationary models. The results suggest significant provincial differences, and the maps provided can guide policymakers in carefully exploiting the available resources for more cost-effective interventions.
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Affiliation(s)
- Ropo E. Ogunsakin
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Private Bag X54001, Durban 4000, South Africa;
- Correspondence:
| | - Themba G. Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Private Bag X54001, Durban 4000, South Africa;
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban 4000, South Africa
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Marbaniang SP, Lhungdim H, Chungkham HS. Identifying the latent classes of modifiable risk behaviours among diabetic and hypertensive individuals in Northeastern India: a population-based cross-sectional study. BMJ Open 2022; 12:e053757. [PMID: 35210340 PMCID: PMC8883275 DOI: 10.1136/bmjopen-2021-053757] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To identify the latent classes of modifiable risk factors among the patients with diabetes and hypertension based on the observed indicator variables: smoking, alcohol, aerated drinks, overweight or obesity, diabetes and hypertension. We hypothesised that the study population diagnosed with diabetes or hypertension is homogeneous with respect to the modifiable risk factors. DESIGN A cross-sectional study using a stratified random sampling method and a nationally representative large-scale survey. SETTING AND PARTICIPANTS Data come from the fourth round of the Indian National Family Health Survey, 2015-2016. Respondents aged 15-49 years who were diagnosed with either diabetes or hypertension or both were included. The total sample is 22 249, out of which 3284 were men and 18 965 were women. PRIMARY AND SECONDARY OUTCOME MEASURES The observed variables used as latent indicators are the following: smoking, alcohol, aerated drinks, overweight or obesity, diabetes and hypertension. The concomitant variables include age, gender, education, marital status and household wealth index. Latent class model was used to simultaneously identify the latent class and to determine the association between the concomitant variables and the latent classes. RESULTS Three latent classes were identified and labelled as class 1: 'diabetic with low-risk lifestyle' (21%), class 2: 'high-risk lifestyle' (8%) and class 3: 'hypertensive with low-risk lifestyle' (71%). Class 1 is characterised by those with a high probability of having diabetes and low probability of smoking and drinking alcohol. Class 2 is characterised by a high probability of smoking and drinking alcohol and class 3 by a high probability of having high blood pressure and low probability of smoking and drinking alcohol. CONCLUSIONS Co-occurrence of smoking and alcohol consumption was prevalent in men, while excess body weight and high blood pressure were prevalent in women. Policy and programmes in Northeastern India should focus on targeting multiple modifiable risk behaviours that co-occur within an individual.
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Affiliation(s)
- Strong P Marbaniang
- Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | - Hemkhothang Lhungdim
- Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | - Holendro Singh Chungkham
- Applied and Official Statistics Unit, Indian Statistical Institute, North-East Centre at Tezpur, Tezpur, India
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Marbaniang SP, Chungkham HS, Lhungdim H. A structured additive modeling of diabetes and hypertension in Northeast India. PLoS One 2022; 17:e0262560. [PMID: 35025967 PMCID: PMC8758063 DOI: 10.1371/journal.pone.0262560] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 12/30/2021] [Indexed: 12/12/2022] Open
Abstract
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.
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Affiliation(s)
- Strong P. Marbaniang
- Department of Public Health & Mortality studies, International Institute for Population Sciences, Mumbai, India
- Department of Statistics, Sankardev College, Shillong, Meghalaya, India
- * E-mail:
| | - Holendro Singh Chungkham
- Indian Statistical Institute, North-East Centre, Tezpur, Assam, India
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Hemkhothang Lhungdim
- Department of Public Health & Mortality studies, International Institute for Population Sciences, Mumbai, India
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Kumar P, Patel R, Muhammad T, Srivastava S. Does engagement in frequent physical activity improve diabetes mellitus among older adults in India? A propensity score matching approach. Diabetes Metab Syndr 2022; 16:102353. [PMID: 34920198 DOI: 10.1016/j.dsx.2021.102353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Diabetes is a major chronic condition and was identified as one of the four priority non-communicable diseases that the United Nations targeted because of its increasing disease burden. The present study aims to examine the impact of physical activity on improving diabetes mellitus among older adults in India. METHODS This study utilizes data from India's first nationally representative longitudinal ageing survey (2017-18). Descriptive along with bivariate analysis was used to present the preliminary results. Additionally, Propensity score matching (PSM) analysis was used. RESULTS About 14% of older adults suffered from diabetes. Eighteen percent of older adults did frequent physical activity. The estimated average treatment effect on the treated (ATT) values in treated and control groups were 0.123 and 0.147, respectively, indicating that the prevalence of diabetes among older adults was reduced by 2.5% points because of frequent physical activity. The average treatment effect on the untreated (ATU) results indicates that among older adults who did not do frequent physical activity, if they did frequent physical activity, the prevalence of diabetes is likely to decrease by 2.2% points. CONCLUSION Our findings show that frequent physical activity is associated with a lower risk of diabetes in older adults. The results underscore the need to develop strategies of promoting an active lifestyle by maintaining physical activity to combat the diabetes epidemic in the older population.
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Affiliation(s)
- Pradeep Kumar
- Population Council, India Country Office, 5A, GF, India Habitat Centre, New Delhi, Delhi, 110003, India.
| | - Ratna Patel
- International Institute for Population Sciences, Mumbai, Maharashtra, 110048, India.
| | - T Muhammad
- International Institute for Population Sciences, Mumbai, Maharashtra, 110048, India.
| | - Shobhit Srivastava
- Department of Research and Innovation, Mamta Health Institute for Mother and Child, New Delhi, 110048, India.
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