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Ortiz-Saavedra B, Montes-Madariaga ES, Moreno-Loaiza O, Toro-Huamanchumo CJ. Hypertension subtypes at high altitude in Peru: Analysis of the Demographic and Family Health Survey 2016-2019. PLoS One 2024; 19:e0300457. [PMID: 38608222 PMCID: PMC11014732 DOI: 10.1371/journal.pone.0300457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/27/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND The prevalence of hypertension in Peru has increased over the years. Approximately one third of the Peruvian population lives at high altitudes. This population presents particular physiological, genetic and environmental characteristics that could be related to the prevalence of hypertension and its subtypes. OBJECTIVE To assess the association between altitude and hypertension in the Peruvian population through an analysis of a nationally representative survey. METHODS We conducted a cross-sectional analysis of the Demographic and Family Health Survey for the period 2016-2019. We included 122,336 individuals aged 18 years and older. Hypertension was defined according to the JNC-7 guidelines. High-altitude location was defined as a residential cluster located above 2,500 meters above sea level. We utilized generalized linear models from the Poisson family with a log-link function to assess the magnitude of the association between high altitude and hypertension. Additionally, we employed multinomial regression models to analyze the association between high altitude and subtypes of hypertension, including isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH). RESULTS In the adjusted Poisson regression model, we found that the prevalence of hypertension among participants living at high altitudes was lower compared to those living at low altitudes (aPR: 0.89; 95% CI: 0.86-0.93). In the adjusted multinomial regression model, we observed a lower prevalence rate of ISH among participants residing at high altitudes (aRPR: 0.68; 95% CI: 0.61-0.73) and a higher prevalence rate of IDH among participants residing at high altitudes (aRPR: 1.60; 95% CI: 1.32-1.94). CONCLUSIONS Residents at high altitudes in Peru have a lower prevalence rate of ISH and a higher prevalence rate of IDH compared to those living at low altitudes. Further studies are needed to determine the influence of other biological, environmental, and healthcare access factors on this relationship.
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Affiliation(s)
| | | | - Oscar Moreno-Loaiza
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brasil
| | - Carlos J. Toro-Huamanchumo
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
- OBEMET Center for Obesity and Metabolic Health, Lima, Peru
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Ma C, Jian C, Guo L, Li W, Zhang C, Wang L, Yuan M, Zhang P, Dong J, He P, Shi L. Adipose Tissue Targeting Ultra-Small Hybrid Nanoparticles for Synergistic Photodynamic Therapy and Browning Induction in Obesity Treatment. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2023:e2308962. [PMID: 37949812 DOI: 10.1002/smll.202308962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 10/25/2023] [Indexed: 11/12/2023]
Abstract
Photodynamic therapy (PDT), as a means of locally and rapidly inducing adipocyte death via light illumination, in combination with adipose browning induction, a more gradual and widespread effect that could transform white adipose tissue into thermogenic adipose tissue, manifests a promising approach to combat obesity. Herein, adipose-targeting ultra-small hybrid nanoparticles (Pep-PPIX-Baic NPs) composed of an adipose-targeting peptide, Fe3+ , a photosensitizer (protoporphyrin IX), and a browning agent (baicalin) are introduced. Pep-PPIX-Baic NPs have been designed to simultaneously enhance the photodynamic effect and induce browning. After intravenous injection in obese mice, the hybrid nanoparticles can specifically accumulate in white adipose tissues, especially those rich in blood supply, and drive adipose reduction owing to the synergy of the PDT effect and baicalin browning induction. Overall, Pep-PPIX-Baic NPs exhibited superior anti-obesity potential through PDT synergistic with adipose browning induction. The designed multifunctional adipose-targeting hybrid nanoparticles present a prospective nanoplatform for obesity treatment.
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Affiliation(s)
- Chuan Ma
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, 250012, China
| | - Chuanjiang Jian
- Department of Pharmacology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, China
| | - Lihao Guo
- Precision Research Center for Refractory Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, China
| | - Wenting Li
- Department of Pharmacology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, China
| | - Cai Zhang
- Department of Pharmacology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, China
| | - Li Wang
- Precision Research Center for Refractory Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, China
| | - Miaomiao Yuan
- Precision Research Center for Refractory Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, China
| | - Peng Zhang
- Department of Pharmacy, The Third Affiliated Hospital (The Affiliated Luohu Hospital) of Shenzhen University, 47 Youyi Road, Shenzhen, 518001, China
| | - Jinqiao Dong
- School of Chemistry and Chemical Engineering, Frontiers Science Center for Transformative Molecules and State Key Laboratory of Metal Matrix Composites, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Ping He
- Department of Pharmacology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, China
| | - Leilei Shi
- Precision Research Center for Refractory Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, China
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Ganie MA, Chowdhury S, Suri V, Joshi B, Bhattacharya PK, Agrawal S, Malhotra N, Sahay R, Jabbar PK, Rozati R, Wani IA, Shukla A, Arora T, Rashid H. Prevalence, Regional Variations, and Predictors of Overweight, Obesity, and Hypertension Among Healthy Reproductive-Age Indian Women: Nationwide Cross-Sectional Polycystic Ovary Syndrome Task Force Study. JMIR Public Health Surveill 2023; 9:e43199. [PMID: 37672315 PMCID: PMC10512112 DOI: 10.2196/43199] [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: 11/22/2022] [Revised: 04/05/2023] [Accepted: 05/16/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND A clear understanding of the anthropometric and sociodemographic risk factors related to BMI and hypertension categories is essential for more effective disease prevention, particularly in India. There is a paucity of nationally representative data on the dynamics of these risk factors, which have not been assessed among healthy reproductive-age Indian women. OBJECTIVE This cross-sectional polycystic ovary syndrome (PCOS) task force study aimed to assess the anthropometric and sociodemographic characteristics of healthy reproductive-age Indian women and explore the association of these characteristics with various noncommunicable diseases. METHODS We conducted a nationwide cross-sectional survey from 2018 to 2022 as part of the Indian Council of Medical Research-PCOS National Task Force study, with the primary aim of estimating the national prevalence of PCOS and regional phenotypic variations among women with PCOS. A multistage random sampling technique was adopted, and 7107 healthy women (aged 18-40 years) from 6 representative geographical zones of India were included in the study. The anthropometric indices and sociodemographic characteristics of these women were analyzed. Statistical analysis was performed to assess the association between exposure and outcome variables. RESULTS Of the 7107 study participants, 3585 (50.44%) were from rural areas and 3522 (49.56%) were from urban areas. The prevalence of obesity increased from 8.1% using World Health Organization criteria to 40% using the revised consensus guidelines for Asian Indian populations. Women from urban areas showed higher proportions of overweight (524/1908, 27.46%), obesity (775/1908, 40.62%), and prehypertension (1008/1908, 52.83%) categories. A rising trend of obesity was observed with an increase in age. Women aged 18 to 23 years were healthy (314/724, 43.4%) and overweight (140/724, 19.3%) compared with women aged 36 to 40 years with obesity (448/911, 49.2%) and overweight (216/911, 23.7%). The proportion of obesity was high among South Indian women, with 49.53% (531/1072) and 66.14% (709/1072), using both World Health Organization criteria and the revised Indian guidelines for BMI, respectively. BMI with waist circumference and waist-to-height ratio had a statistically significant linear relationship (r=0.417; P<.001 and r=0.422; P<.001, respectively). However, the magnitude, or strength, of the association was relatively weak (0.3<|r|<0.5). Statistical analysis showed that the strongest predictors of being overweight or obese were older age, level of education, wealth quintile, and area of residence. CONCLUSIONS Anthropometric and sociodemographic characteristics are useful predictors of overweight- and obesity-related syndromes, including prehypertension, among healthy Indian women. Increased attention to the health of Indian women from public health experts and policy makers is warranted. The findings of this study can be leveraged to offer valuable insights, informing health decision-making and targeted interventions that mitigate risk factors of overweight, obesity, and hypertension. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/23437.
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Affiliation(s)
- Mohd Ashraf Ganie
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Subhankar Chowdhury
- Department of Endocrinology, Institute of Postgraduate Medical Education & Research, Kolkata, India
| | - Vanita Suri
- Department of Obstetrics & Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Beena Joshi
- Department of Operational Research, National Institute for Research in Reproductive Health, Indian Council of Medical Research (ICMR), Mumbai, India
| | - Prasanta Kumar Bhattacharya
- Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Meghalaya, India
| | - Sarita Agrawal
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, Chatisgarh, India
| | - Neena Malhotra
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, India
| | | | - Roya Rozati
- Department of Obstetrics & Gynaecology, Maternal Health & Research Trust, Hyderabad, India
| | - Imtiyaz Ahmad Wani
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Amlin Shukla
- Reproductive Biology and Maternal Health, Indian Council of Medical Research (ICMR), New Delhi, India
| | - Taruna Arora
- Reproductive Biology and Maternal Health, Indian Council of Medical Research (ICMR), New Delhi, India
| | - Haroon Rashid
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
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Woolcott OO, Seuring T, Castillo OA. Lower Prevalence of Body Fat-Defined Obesity at Higher Altitudes in Peruvian Adults. High Alt Med Biol 2023; 24:214-222. [PMID: 37327017 DOI: 10.1089/ham.2022.0097] [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] [Indexed: 06/17/2023] Open
Abstract
Woolcott, Orison O., Till Seuring, and Oscar A. Castillo. Lower prevalence of body fat-defined obesity at higher altitudes in Peruvian adults. High Alt Med Biol. 24:214-222, 2023. Background: Previous studies have reported a lower prevalence of obesity (defined as a body mass index [BMI] ≥30 kg/m2) in populations from higher altitudes. Since BMI does not distinguish fat mass and fat-free mass, it is unclear whether there is an inverse association between altitude and body fat-defined obesity. Methods: We performed an analysis of cross-sectional data to examine the association between altitude and body fat-defined obesity (as opposed to BMI-defined obesity) using individual-level data from a nationally representative sample of the Peruvian adult population living between 0 and 5,400 m altitude. Body fat-defined obesity was diagnosed using the relative fat mass (RFM), an anthropometric index validated to estimate whole-body fat percentage. RFM cutoffs for obesity diagnosis were ≥40% for women and ≥30% for men. We utilized Poisson regression to estimate the prevalence ratio and confidence intervals (CIs) as the measure of the association, adjusting for age, cigarette use, and diabetes. Results: Analysis comprised 36,727 individuals (median age, 39 years; 50.1% women). In rural areas, for a one-km increase in altitude, the prevalence of body fat-defined obesity decreased by 12% among women (adjusted prevalence ratio: 0.88; 95% CI, 0.86 - 0.90; p < 0.001) and 19% among men (adjusted prevalence ratio: 0.81; 95% CI, 0.77 - 0.86; p < 0.001), on average, when all the other variables were held constant. The inverse association between altitude and obesity was less strong in urban areas than in rural areas but remained significant among women (p = 0.001) and men (p < 0.001). However, the relationship between altitude and obesity in women who live in urban areas appears to be nonlinear. Conclusions: In Peruvian adults, the prevalence of body fat-defined obesity was inversely associated with altitude. Whether this inverse association is explained by altitude per se or confounded by socioeconomic or other environmental factors, or differences in race/ethnicity or lifestyle, warrants further investigation.
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Affiliation(s)
- Orison O Woolcott
- Institute for Globally Distributed Open Research and Education (IGDORE), Los Angeles, California, USA
- Ronin Institute, Montclair, New Jersey, USA
| | - Till Seuring
- Luxembourg Institute of Socio-Economic Research (LISER), Esch-sur-Alzette, Luxembourg
| | - Oscar A Castillo
- National Institute of Andean Biology, Universidad Nacional Mayor de San Marcos, Lima, Peru
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Verma A, Singh G, Agrawal R, Tripathi N. Overweight and obesity, the clock ticking in India? A secondary analysis of trends of prevalence, patterns, and predictors from 2005 to 2020 using the National Family Health Survey. INTERNATIONAL JOURNAL OF NONCOMMUNICABLE DISEASES 2023. [DOI: 10.4103/jncd.jncd_58_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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Drivers and distribution of the household-level double burden of malnutrition in Bangladesh: analysis of mother-child dyads from a national household survey. Public Health Nutr 2022; 25:3158-3171. [PMID: 36111605 PMCID: PMC9991823 DOI: 10.1017/s1368980022002075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The double burden of malnutrition (DBM) has become an emerging public health issue in many low- and middle-income countries. This study aims to provide important evidence for the prevalence of different types of DBM at the national and subnational levels in Bangladesh. DESIGN The study utilised data from the latest Bangladesh Demographic and Health Survey (BDHS) 2017-2018. Multivariable logistic regression was performed to identify the sociodemographic factors associated with DBM. SETTING Nationally representative cross-sectional survey. PARTICIPANTS 8697 mothers aged 15 to 49 years with <5 children. RESULTS The overall prevalence of the DBM was approximately 21 %, where the prevalence of overweight mother (OWM) & stunted child/wasted child/underweight child (SC/WC/UWC) and underweight mother (UWM) & overweight child (OWC) was 13·35 % and 7·69 %, respectively, with a higher prevalence among urban households (OWM & SC/WC/UWC = 14·22 %; UWM & OWC = 10·58 %) in Bangladesh. High inequality was observed among UWM & OWC dyads, concentration index (CI) = -0·2998, while low level of inequality of DBM were observed for OWM & SC (CI = 0·0153), OWM & WC (CI = 0·1165) and OWM & UWC (CI = 0·0135) dyads. We observed that the age and educational status of the mother, number of children, fathers' occupation, size and wealth index of the household, and administrative division were significantly associated with all types of DBM. CONCLUSIONS Health policymakers, concerned authorities and various stakeholders should stress the prevalence of DBM issues and take necessary actions aimed at identifying and addressing the DBM in Bangladesh.
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Gardner H, Miles G, Saleem A, Dunin-Borkowska A, Mohammad H, Puttick N, Aksha S, Bhattarai S, Keene C. Social determinants of health and the double burden of disease in Nepal: a secondary analysis. BMC Public Health 2022; 22:1567. [PMID: 35978424 PMCID: PMC9387078 DOI: 10.1186/s12889-022-13905-3] [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: 04/01/2022] [Accepted: 07/28/2022] [Indexed: 11/12/2022] Open
Abstract
Background As the global burden of disease evolves, lower-resource countries like Nepal face a double burden of non-communicable and infectious disease. Rapid adaptation is required for Nepal’s health system to provide life-long, person-centred care while simultaneously improving quality of infectious disease services. Social determinants of health be key in addressing health disparities and could direct policy decisions to promote health and manage the disease burden. Thus, we explore the association of social determinants with the double burden of disease in Nepal. Methods This is a retrospective, ecological, cross-sectional analysis of infectious and non-communicable disease outcome data (2017 to 2019) and data on social determinants of health (2011 to 2013) for 753 municipalities in Nepal. Multinomial logistic regression was conducted to evaluate the associations between social determinants and disease burden. Results The ‘high-burden’ combined double burden (non-communicable and infectious disease) outcome was associated with more accessible municipalities, (adjOR3.94[95%CI2.94–5.28]), municipalities with higher proportions of vaccine coverage (adjOR12.49[95%CI3.05–51.09]) and malnutrition (adjOR9.19E103[95%CI19.68E42-8.72E164]), lower average number of people per household (adjOR0.32[95%CI0.22–0.47]) and lower indigenous population (adjOR0.20[95%CI0.06–0.65]) compared to the ‘low-burden’ category on multivariable analysis. ‘High-burden’ of non-communicable disease was associated with more accessible municipalities (adjOR1.93[95%CI1.45–2.57]), higher female proportion within the municipality (adjOR1.69E8[95%CI3227.74–8.82E12]), nutritional deficiency (adjOR1.39E17[95%CI11799.83–1.64E30]) and malnutrition (adjOR2.17E131[95%CI4.41E79-1.07E183]) and lower proportions of population under five years (adjOR1.05E-10[95%CI9.95E-18–0.001]), indigenous population (adjOR0.32[95%CI0.11–0.91]), average people per household (adjOR0.44[95%CI0.26–0.73]) and households with no piped water (adjOR0.21[95%CI0.09–0.49]), compared to the ‘low-burden’ category on adjusted analysis. ‘High burden’ of infectious disease was also associated with more accessible municipalities (adjOR4.29[95%CI3.05–6.05]), higher proportions of population under five years (adjOR3.78E9[95%CI9418.25–1.51E15]), vaccine coverage (adjOR25.42[95%CI7.85–82.29]) and malnutrition (adjOR4.29E41[95%CI12408.29–1.48E79]) and lower proportions of households using firewood as fuel (adjOR0.39[95%CI0.20–0.79]) (‘moderate-burden’ category only) compared to ‘low-burden’. Conclusions While this study produced imprecise estimates and cannot be interpreted for individual risk, more accessible municipalities were consistently associated with higher disease burden than remote areas. Female sex, lower average number per household, non-indigenous population and poor nutrition were also associated with higher burden of disease and offer targets to direct interventions to reduce the burden of infectious and non-communicable disease and manage the double burden of disease in Nepal. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13905-3.
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Affiliation(s)
- Hannah Gardner
- Institute of Human Sciences, University of Oxford, Oxford, UK.
| | - Georgina Miles
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Ayesha Saleem
- UCL Medical School, University College London, London, UK
| | | | - Hannah Mohammad
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Natasha Puttick
- Institute of Human Sciences, University of Oxford, Oxford, UK
| | - Sanam Aksha
- School of Public Administration, National Center for Integrated Coastal Research, University of Central Florida, Orlando, USA
| | - Suraj Bhattarai
- Department of Global Health, Global Institute for Interdisciplinary Studies, Kathmandu, Nepal
| | - Claire Keene
- Health Systems Collaborative, Oxford Centre for Global Health Research, University of Oxford, Oxford, UK
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Sarker AR, Ali SMZ, Ahmed M, Chowdhury SMZI, Ali N. Out-of-pocket payment for healthcare among urban citizens in Dhaka, Bangladesh. PLoS One 2022; 17:e0262900. [PMID: 35073368 PMCID: PMC8786169 DOI: 10.1371/journal.pone.0262900] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 01/09/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives Out-of-pocket (OOP) payment is the major payment strategy for healthcare in Bangladesh, and the share of OOP expenditure has increased alarmingly. Dhaka is recognised as one of the fastest-growing megacities in the world. The objective of this study is to capture the self-reported illnesses among urban citizens and to identify whether and to what extent socioeconomic, demographic and behavioural factors of the population influence OOP healthcare expenditures. Subject and methods This study utilises cross-sectional survey data collected from May to August 2019 in urban Dhaka, Bangladesh. A total of 3,100 households were randomly selected. Simple descriptive statistics including frequencies, percentage, mean (95% CI), median and inter-quartile range were presented. Bivariate analysis and multivariate regression models were employed. Results We observed that acute illnesses (e.g., fever, flu/cough) were dominant among participants. Among the chronic illnesses, approximately 9.6% of people had diabetes, while 5.3% had high/low blood pressure. The richest quintile only spent 5.2% of their household income on healthcare, while the poorest households spent approximately six times more than the richest households. We noted that various factors such as marital status, religion, source of care, access to safe water, income quintile and even the location of households had a significant relationship with OOP expenditure. Conclusions Our findings can serve as important source of data in terms of disease- specific symptoms and out-of-pocket cost among urban citizens in Dhaka. The people belonging to wealthier households tended to choose better healthcare facilities and spend more. A pro-poor policy initiative and even an urban health protection scheme may be necessary to ensure that healthcare services are accessible and affordable, in line with the Bangladesh National Urban Health Strategy.
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Affiliation(s)
| | - S. M. Zulfiqar Ali
- Bangladesh Institute of Development Studies, Agargaon, Dhaka, Bangladesh
| | - Maruf Ahmed
- Bangladesh Institute of Development Studies, Agargaon, Dhaka, Bangladesh
| | | | - Nausad Ali
- Bangladesh Institute of Development Studies, Agargaon, Dhaka, Bangladesh
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Zhou W, Wang W, Fan C, Zhou F, Ling L. Residential elevation and its effects on hypertension incidence among older adults living at low altitudes: a prospective cohort study. Environ Health Prev Med 2022; 27:19. [PMID: 35527011 PMCID: PMC9251620 DOI: 10.1265/ehpm.22-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Research on the relationship between residential altitude and hypertension incidence has been inconclusive. Evidence at low altitudes (i.e., <1,500 m) is scarce, let alone in older adults, a population segment with the highest hypertension prevalence. Thus, the objective of this study is to determine whether hypertension risk may be affected by altitude in older adults living at low altitudes. Methods This prospective cohort study collected data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). We selected 6,548 older adults (≥65 years) without hypertension at baseline (2008) and assessed events by the follow-up surveys done in 2011, 2014, and 2018 waves. The mean altitude of 613 residential units (county or district) in which the participants resided was extracted from the Digital Elevation Model (DEM) of the National Aeronautics and Space Administration (NASA) and was accurate to within 30 m. The Cox regression model with penalized splines examined the linear or nonlinear link between altitude and hypertension. A random-effects Cox regression model was used to explore the linear association between altitude and hypertension. Results The overall rate of incident hypertension was 8.6 per 100-person years. The median altitude was 130.0 m (interquartile range [IQR] = 315.5 m). We observed that the exposure–response association between altitude and hypertension incidence was not linear. The shape of the exposure–response curve showed that three change points existed. Hypertension risk increased from the lowest to the first change point (247.1 m) and slightly fluctuated until the last change point (633.9 m). The risk decreased above the last change point. According to the categories stratified by the change points, altitude was only significantly associated with hypertension risk (hazard ratio [HR] = 1.003; 95% confidence interval [CI] = 1.002–1.005) under the first change point (247.1 m) after adjusting for related covariates. Conclusion Our study found that the association between altitude and hypertension risk might not be linear. We hope the further study can be conducted to confirm the generality of our findings. Supplementary information The online version contains supplementary material available at https://doi.org/10.1265/ehpm.22-00001.
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Affiliation(s)
- Wensu Zhou
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University
| | - Wenjuan Wang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University
| | - Chaonan Fan
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University
| | - Fenfen Zhou
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University
| | - Li Ling
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University
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