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Nyarko SH, Addo IY, Ayebeng C, Dickson KS, Acquah E. Mediating effects of hypertension in association between household wealth disparities and diabetes among women of reproductive age: analysis of eight countries in sub-Saharan Africa. Int Health 2024:ihae013. [PMID: 38321706 DOI: 10.1093/inthealth/ihae013] [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: 08/14/2023] [Revised: 12/19/2023] [Accepted: 01/15/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Diabetes prevalence appears to be increasing in low- and middle-income countries, yet little is known about how hypertension status mediates the association between household wealth and diabetes. This study examined the mediation effects of hypertension in associations between household wealth and diabetes in eight sub-Saharan African (SSA) countries. METHODS This is a cross-sectional study of 71 577 women from recent Demographic and Health Surveys for eight SSA countries. Sample-weighted logistic regression and causal mediation analyses were conducted. RESULTS Of the 71 577 women, 1.1% (782) reported ever being diagnosed with diabetes. Women with diabetes were more likely to have hypertension compared with those without diabetes (54.9% vs 9.9%). The odds of diabetes were significantly higher among women with hypertension (adjusted odds ratio [OR] 5.71 [95% confidence interval {CI} 4.62 to 7.05]) and women from rich households (adjusted OR 1.65 [95% CI 1.23 to 2.22]) compared with their respective counterparts. Hypertension status mediated 27.4% of the association between household wealth and diabetes status. CONCLUSIONS Hypertension status partly contributes to the associations between household wealth disparities and diabetes status among women in the selected countries. Further research and targeted interventions are needed to explore specific mechanisms and confounding factors related to household wealth disparities, hypertension status and diabetes prevalence in this population.
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Affiliation(s)
- Samuel H Nyarko
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Isaac Y Addo
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Castro Ayebeng
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- Department of Research and Advocacy, Challenging Heights, Winneba, Ghana
| | - Kwamena S Dickson
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Evelyn Acquah
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
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Ulambayar B, Ghanem AS, Kovács N, Trefán L, Móré M, Nagy AC. Cardiovascular disease and risk factors in adults with diabetes mellitus in Hungary: a population-based study. Front Endocrinol (Lausanne) 2023; 14:1263365. [PMID: 37780630 PMCID: PMC10538629 DOI: 10.3389/fendo.2023.1263365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/01/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Diabetes mellitus (DM) and cardiovascular disease (CVD) such as acute myocardial infarction, stroke, and coronary artery disease are highly prevalent conditions that are responsible for significant morbidity and mortality, particularly in Hungary. The conditions are attributed to identical risk factors, and individuals with DM are primarily susceptible to cardiovascular complications, which are the leading causes of death and disability in patients with DM. The objective of this study was to estimate the prevalence of CVD in individuals with DM and to investigate the association between potential risk factors and the presence of CVD among individuals with DM in a population-based sample. Methods The study was based on data from three waves of the European Health Interview Surveys (EHIS) conducted in Hungary in 2009, 2014, and 2019. Results The prevalence of CVD among patients with DM decreased during the study period and that socioeconomic factors, cardiometabolic risk factors including high blood pressure and high cholesterol, and depression are major contributors to CVD burden in patients with DM in Hungary. Discussion Our findings suggest the importance of regular check-up for hypertension and hypercholesterolemia, better focus on socioeconomic status, as well as ongoing monitoring of mental health among patients with diabetes. Further research is needed to understand the potential causes behind the observed decrease in CVD prevalence.
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Affiliation(s)
- Battamir Ulambayar
- Department of Health Informatics, Institute of Health Informatics, Faculty of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Amr Sayed Ghanem
- Department of Health Informatics, Institute of Health Informatics, Faculty of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Nóra Kovács
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - László Trefán
- Department of Health Informatics, Institute of Health Informatics, Faculty of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Marianna Móré
- Institute of Social and Sociological Sciences, Faculty of Health Sciences, University of Debrecen, Nyíregyháza, Hungary
| | - Attila Csaba Nagy
- Department of Health Informatics, Institute of Health Informatics, Faculty of Health Sciences, University of Debrecen, Debrecen, Hungary
- Coordinating Centre for Epidemiology, University of Debrecen, Debrecen, Hungary
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Shirin Sara S, Talukder A, Lee KY, Basak N, Rahman Razu S, Haq I, Nath CD. Dynamic changes in prevalence of type 2 diabetes along with associated factors in Bangladesh: Evidence from two national cross-sectional surveys (BDHS 2011 and BDHS 2017-18). Diabetes Metab Syndr 2023; 17:102706. [PMID: 36657306 DOI: 10.1016/j.dsx.2023.102706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 01/04/2023] [Accepted: 01/07/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS Prevalence of type 2 diabetes has been rising rapidly especially in low- and middle-income countries. The purpose of this study is to analyze the prevalence of type 2 diabetes in 2011 and 2017-18, and the risk factors based on the Bangladesh Demographic and Health Surveys (BDHS). METHODS The study comprised of data from the BDHS 2011 and the BDHS 2017-18 with 7565 (50.6% female) and 12,299 respondents (56.9% female) respectively. The plasma blood glucose was classified into normal, pre-diabetes, and diabetes categories. While univariate analysis was performed to determine the data, Chi-square and gamma analyses were used for bivariate estimation of the correlation between diabetes status and other comorbidities. Multinomial and ordinal logistic regression were also performed to trace the link between diabetes and various risk factors. RESULTS The 2011 BDHS survey indicated that nearly half of the participants (47.6%) had pre-diabetic condition, while 10.2% were diagnosed with diabetes. On the other hand, the BDHS 2017-18 demonstrated that 28.6% and 8.6% of participants had pre-diabetes and diabetes, respectively. Results of inferential statistics showed that gender (p<0.05), age, wealth status, physical activity, BMI (p<0.01), and caffeinated beverages (p<0.05), were significantly linked with diabetes status. CONCLUSION According to our findings, older people and people with lower education are more likely to develop diabetes. BMI` Physically active, wealth status, diet and lifestyle were significant predictors of type 2 diabetes. Healthy lifestyle, physical activities, proper knowledge and awareness can reduce the risk of T2D.
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Affiliation(s)
- Sabiha Shirin Sara
- Statistics Discipline, Science Engineering and Technology School, Khulna University, Khulna, 9208, Bangladesh.
| | - Ashis Talukder
- Statistics Discipline, Science Engineering and Technology School, Khulna University, Khulna, 9208, Bangladesh.
| | - Ka Yiu Lee
- Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden.
| | - Nayan Basak
- Statistics Discipline, Science Engineering and Technology School, Khulna University, Khulna, 9208, Bangladesh.
| | | | - Iqramul Haq
- Department of Agricultural Statistics, Sher-e-Bangla Agricultural University, Dhaka, 1207, Bangladesh.
| | - Chuton Deb Nath
- Mass Communication and Journalism Discipline, Khulna University, Khulna, 9208, Bangladesh.
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Nguyen PH, Tauseef S, Khuong LQ, Das Gupta R, Billah SM, Menon P, Scott S. Underweight, overweight or obesity, diabetes, and hypertension in Bangladesh, 2004 to 2018. PLoS One 2022; 17:e0275151. [PMID: 36178894 PMCID: PMC9524627 DOI: 10.1371/journal.pone.0275151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 09/12/2022] [Indexed: 01/14/2023] Open
Abstract
Background and objectives Bangladesh is experiencing a nutrition transition with an increase in the double burden of malnutrition and non-communicable diseases (NCDs). This study sought to: 1) examine trends and differences in underweight, overweight/obesity, hypertension and diabetes by gender, area of residence, and wealth in Bangladesh from 2004 to 2018, 2) assess what factors contributed to changes in these outcomes. Methods We used data from five rounds of the Bangladesh Demographic and Health Surveys (n = 76,758 women 15-49y and 10,900 men 18-95y in total). We calculated differences, slope index of inequality (SII) and concentration index (CIX) to examine trends over time and differences in outcomes by wealth and residence. We identified determinants and estimated drivers of changes in outcomes using regression-based decomposition. Results Between 2004 and 2018, underweight prevalence decreased in both women (33% to 12%) and men (26% to 18%), whereas overweight/obesity increased (17% to 49% in women and 21% to 34% in men). Hypertension also increased in both women (31% to 44%) and men (19% to 33%) while diabetes changed marginally (11% to 14%). In all years, underweight was concentrated in poorer and rural households while overweight/obesity, diabetes and hypertension were concentrated in wealthier and urban households. Wealth inequity decreased over time for underweight, changed little for overweight/obesity, and increased for hypertension and diabetes among men. Increases in wealth explained 35% to 50% of the reduction in underweight and 30% to 57% of the increase in overweight/obesity. Conclusion Our findings imply that double duty actions are required to sustain the decrease in undernutrition and slow the increase in overweight/obesity and NCDs across diverse socioeconomic sections of the population in Bangladesh.
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Affiliation(s)
- Phuong Hong Nguyen
- International Food Policy Research Institute, Washington, DC, United States of America
- * E-mail:
| | | | | | - Rajat Das Gupta
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Sk. Masum Billah
- International Centre for Diarrheal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
- The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - Purnima Menon
- International Food Policy Research Institute, Washington, DC, United States of America
| | - Samuel Scott
- International Food Policy Research Institute, Washington, DC, United States of America
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Haider MR, Gupta RD. Inequalities in Undiagnosed Hypertension Among Adult Population in Bangladesh: Evidence from a Nationally Representative Survey. High Blood Press Cardiovasc Prev 2021; 29:57-64. [PMID: 34757583 DOI: 10.1007/s40292-021-00488-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/03/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Bangladesh has experienced a rising trend in hypertension in recent years and women are suffering from this non-communicable disease more than men. About one-fifth of the adult population is suffering from hypertension and almost three-fifth of them are undiagnosed. AIM This study aims to assess the prevalence and determinants of undiagnosed hypertension and to examine the extent of socioeconomic inequalities in undiagnosed hypertension among adult Bangladeshi population (≥ 18 years). METHODS This study used nationally representative Bangladesh Demographic and Health Survey 2017-18 data. Undiagnosed hypertension was defined as having systolic blood pressure (SBP) ≥ 140 mmHg or diastolic blood pressure (DBP) ≥ 90 mmHg and was never told by the health professionals to lower/control blood pressure. Multiple logistic regression analysis was performed to assess factors associated with undiagnosed hypertension. Further, socioeconomic inequalities in the prevalence of undiagnosed hypertension were estimated using Concentration Index. RESULTS Out of total 3196 hypertensive adults, half (50.1%) were undiagnosed. In the adjusted model, older age, overweight/obesity, female gender, richest wealth quintiles had lower odds of being undiagnosed. Overall concentration index showed that poor patients were disproportionately affected by undiagnosed hypertension (Concentration Index: - 0.103, Standard Error (SE) of Concentration Index: 0.024; P value < 0.001). The poor(Q1)-to-rich(Q5) ratio of 1.3 also demonstrates that poorest hypertensive Bangladeshi adults have higher prevalence of undiagnosed hypertension than their richest counterparts. CONCLUSION Awareness building program should be targeted towards adults belong to poor wealth quintiles for checking blood pressure regularly. Hypertension should be diagnosed and treated to prevent further complications.
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Affiliation(s)
- Mohammad Rifat Haider
- Department of Health Policy and Management, College of Public Health, University of Georgia, Wright Hall 301B, 100 Foster Rd, Athens, GA, 30602, USA.
| | - Rajat Das Gupta
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Discovery I, Columbia, SC, 29208, USA
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