Inequality in the treatment of diabetes and hypertension across residency status in China

Inequality in health opportunities in Indonesia: long-term influence of early-life circumstances on health

Background

This study explores inequality of opportunity in terms of the health of adult Indonesian people, associated with household and parental circumstances in childhood and adolescence.

Methods

Exploiting the longitudinal nature of the Indonesian Family Life Survey, this study measures inequalities relating to being underweight, overweight, hypertensive and diabetic across adult Indonesians aged between 20 and 35 through the dissimilarity index. This study explores their determinants by decomposing the observed inequality levels into contributing factors. Moreover, this study sheds light on the underlying mechanisms through which early-life circumstances influence the health of grown-up respondents, by estimating the intermediate effects of early-life circumstances on current lifestyles.

Results

For all health conditions, health risks are unequally distributed (all p<0.01). Demographic factors and parental health are major contributors to inequalities relating to being underweight, overweight and hypertensive. Family structure and parental occupation are major contributors to inequality in diabetes. The greater part of this inequality is explained by the indirect pathways through which early-life circumstances mediate current diet and exercise habits.

Conclusions

The results suggest that such interventions that compensate for disadvantaged early-life circumstances would be essential in reducing future health risks and mitigating health inequality.

Supplementary Information

The online version contains supplementary material available at (10.1186/s12889-022-13714-8).

Impact of urbanisation on the gaps of hypertension prevalence, awareness and treatment among older age in China: a cross-sectional study

OBJECTIVES

To examine the impact of urbanisation on the prevalence, awareness and treatment of hypertension among elderly in China.

DESIGN

This cross-sectional study used data from the most recent nationally representative Chinese Longitudinal Healthy Longevity Survey, 2018.

SETTING

People in urban and rural communities from 500 sample areas in 22 Chinese provinces.

PARTICIPANTS

After exclusion, this study surveyed 9859 participants in the final analysis.

PRIMARY AND SECONDARY OUTCOME MEASURES

The main dependent variables were prevalence, awareness and treatment of hypertension defined as (1) systolic blood pressure (BP)≥140 mm Hg, diastolic BP≥90 mm Hg or (2) taking antihypertensive drugs. Hypertension awareness was defined as a previous diagnosis of hypertension by a health professional, and hypertension treatment was defined as undergoing BP treatment.

RESULTS

The prevalence of hypertension was lower among semiurbanised adults than among non-urbanised rural adults (OR=0.94, 95% CI=0.90 to 0.99; p<0.05). The probabilities of awareness (OR=1.10, 95% CI=1.01 to 1.20; p<0.05) and treatment (OR=1.17, 95% CI=1.08 to 1.26; p<0.001) of hypertension were significantly lower among non-urbanised adults than among urban-born adults. Urbanisation in eastern (OR=0.93, 95% CI=0.88 to 0.99; p<0.05) and western China (OR=1.11, 95% CI=1.01 to 1.23; p<0.05) was associated with the prevalence of hypertension. The urbanisation level was also associated with hypertension awareness and treatment in eastern (OR=1.17, 95% CI=1.04 to 1.32; p<0.01; OR=1.26, 95% CI=1.14 to 1.40; p<0.001), central (OR=1.31, 95% CI=1.05 to 1.63; p<0.05; OR=1.29, 95% CI=1.08 to 1.55; p<0.01) and western China (OR=1.28, 95% CI=1.07 to 1.53; p<0.01; OR=1.34, 95% CI=1.15 to 1.57; p<0.001). The Blinder-Oaxaca decomposition suggested that approximately 42% and 39% of the urban-rural gap in hypertension awareness and treatment, respectively, could be attributed to coefficient difference.

CONCLUSIONS

Public health programmes and policies for chronic diseases should adjust with urbanisation and combine individual-centred strategies.

Impact of diabetes on COVID-19 mortality and hospital outcomes from a global perspective: An umbrella systematic review and meta-analysis

INTRODUCTION

To date, COVID-19 has claimed 4.9 million lives. Diabetes has been identified as an independent risk factor of serious outcomes in people with COVID-19 infection. Whether that holds true across world regions uniformly has not been previously assessed.

METHODS

This study offers the first umbrella systematic review and meta-analysis to analyse the collective and geographically stratified mortality, ICU admission, ventilation requirement, illness severity and discharge rate amongst patients with diabetes. Five databases (EMBASE, MEDLINE, CAB Abstracts, PsychInfo and Web of Science) and 3 additional sources (SSRN's eLibrary, Research Square and MedRxiv) were searched from inception to 30 August 2021. Prospective and retrospective cohort studies, reporting the association between diabetes and one or more COVID-19 hospitalization outcomes, were included. This meta-analysis was registered on PROSPERO, CRD42021278579. Abbreviated MeSH terms used for search were as follows: (Diabetes) AND (2019 Novel Coronavirus Disease), adapted per database requirements. Exclusion criteria exclusion criteria were as follows: (1) none of the primary or secondary outcomes of meta-analysis reported, (2) no confirmed COVID-19 infection (laboratory or clinical) and (3) no unexposed population (solely patients with diabetes included). Quality of the included studies were assessed using the Newcastle-Ottawa Scale (NOS) whilst quality of evidence by the GRADE framework. Studies that were clinically homogeneous were pooled. Summative data and heterogeneity were generated by the Cochrane platform RevMan (V. 5.4).

RESULTS

Overall, 158 observational studies were included, with a total of 270,212 of participants, median age 59 [53-65 IQR] of who 56.5% were male. A total of 22 studies originated from EU, 90 from Far East, 16 from Middle East and 30 from America. Data were synthesized with mixed heterogeneity across outcomes. Pooled results highlighted those patients with diabetes were at a higher risk of COVID-19-related mortality, OR 1.87 [95%CI 1.61, 2.17]. ICU admissions increased across all studies for patients with diabetes, OR 1.59 [95%CI 1.15, 2.18], a result that was mainly skewed by Far East-originating studies, OR 1.94 [95%CI 1.51, 2.49]. Ventilation requirements were also increased amongst patients with diabetes worldwide, OR 1.44 [95%CI 1.20, 1.73] as well as their presentation with severe or critical condition, OR 2.88 [95%CI 2.29, 3.63]. HbA1C levels under <70 mmol and metformin use constituted protective factors in view of COVID-19 mortality, whilst the inverse was true for concurrent insulin use.

CONCLUSIONS

Whilst diabetes constitutes a poor prognosticator for various COVID-19 infection outcomes, variability across world regions is significant and may skew overall trends.

Prevalence and factors associated with arterial hypertension in a Brazilian rural working population

OBJECTIVES

To determine the prevalence of hypertension and associated factors in farmers in a rural region of Brazil.

METHODS

A cross-sectional study was conducted involving a sample of 790 farmers who were residents of Espírito Santo, Brazil.

RESULTS

The prevalence of hypertension was 35.8% (95%CI: 32.5-39.1%, n=283); however, it was higher in men (36.6%, n=151, p<0.001) and in those with excess weight (48.9%, n=197, p<0.001). Of the 283 hypertensive patients, 125 (44.2%) did not use antihypertensive drugs. In men, lower level of schooling (p=0.004), working in the field for fewer daily hours (p<0.001), and having greater abdominal adiposity (p=0.039) were associated with the presence of increased blood pressure. In women, age (p=0.002), lower schooling (p=0.021), and increased central adiposity (p=0.003) were independent predictors of blood pressure.

CONCLUSION

The highest prevalence of hypertension was observed in men, with elevated blood pressure being strongly associated with social and economic factors. In women, the association with the classic factors (age, increase in abdominal adiposity, and low schooling) was stronger. In addition, most hypertensive patients are not adequately diagnosed or treated.

Ex-ante Inequality of Opportunity in Child Malnutrition: New Evidence from Ten Developing Countries in Asia

This study explores the inequality of opportunity in child malnutrition in ten developing countries in Asia, where a high proportion of children still remain vulnerable to food insecurity. This study takes account of multidimensional aspects of household and parental socio-economic status, and partitions children into distinct types through a data-driven clustering method. This is followed by a comparison of the malnutrition rates between types. Next, we decompose the observed disparity into the factors that are associated with the between-type disparity in malnutrition rates through a non-linear decomposition method. The results indicate that in all 10 countries, significant between-type disparities are found. We find the largest difference in Pakistan as 21.7 percentage points and the smallest difference in Maldives as 5.9 percentage points. In five of the ten countries, the difference in household affluence explains the largest part of the observed between-type disparity. All the results suggest that priority should be given to protecting children from marginalised households in order to mitigate the inequality in child health.

The impact of health insurance on out-of-pocket expenditure on delivery in Indonesia

In this study, we estimate the effects of health insurance on the out-of-pocket expenditure on health care for maternal delivery in Indonesia. Distinguishing between the types of health insurance, we explore heterogeneity in the size of the impact of noncontributory insurance for poor households vis-à-vis contributory insurance for nonpoor households. We find that noncontributory insurance and contributory insurance reduce the average out-of-pocket expenditure by 1,136,966 IDR ([Formula: see text]) and 676,402 IDR ([Formula: see text]), respectively. Also, larger impacts of noncontributory insurance and contributory insurance are found at the right tail of the distribution.

Urban developments and health: Evidence from the distributional analysis of biomarkers in China

This study explores the association between urban developments and health in China, a country that has experienced unprecedented economic growth and consequential rapid urbanisation over the last few decades. Exploiting the Chinese Health and Nutrition Survey, this study analyses the effect of these urban developments on the entire distribution of 11 objectively measured health outcomes related to non-communicable diseases. Quantification of the effects on health distribution is achieved by estimating health distribution in a counter-factual situation in which every individual is exposed to the minimum level of urban development. In decomposing the estimated effect into the part attributable to the observed path through which urban developments change observed health-related behaviours (behavioural effect), and the remaining part which cannot be attributable to this observed path (non-behavioural effect), this study sheds light on the mechanisms underlying how urban developments are associated with health outcomes. The results indicate that urban developments are negatively associated in this regard, especially with health outcomes related to body lipids such as triglycerides and cholesterols, blood pressure and kidney-related biomarkers. Furthermore, the results provide strong evidence of heterogeneity in the degrees of association across the distribution.