Gender disparities in the association between socio-demographics and non-communicable disease risk factors among adults with disabilities in Shanghai, China

Almost all working adults have at least one risk factor for non-communicable diseases: Survey of working adults in Eastern Ethiopia

Introduction

The disease burden and mortality related to Non-communicable Diseases (NCD) increased in the last couple of decades in Ethiopia. As a result, an estimated 300,000 deaths per annum were due to NCD. According to a World Health Organization report, 39% of the total deaths in Ethiopia were attributable to NCD. Rapid urbanization characterized by unhealthy lifestyles such as tobacco and/or alcohol use, physical inactivity, low fruits and vegetable consumption, and overweight drive the rising burden of NCD. However, studies on risk factors for NCD and associated variables are limited among working adults in Eastern Ethiopia. Therefore, this study aimed to examine the magnitude of the risk factors of NCD and associated factors among working adults in Eastern Ethiopia.

Methods

A cross-sectional study was carried out among 1,200 working adults in Eastern Ethiopia that were selected using a simple random sampling technique from December 2018 to February 2019. Data were collected following the World Health Organization Stepwise Approach to NCD Risk Factor Surveillance (WHO STEP) instruments translated into the local language. A total of five risk factors were included in the study. The Negative Binomial Regression Model was used to determine the association between NCD risk factor scores and other independent variables. Adjusted incidence rate ratio (AIRR) with a 95% Confidence Interval (CI) was used to report the findings while the association was declared significant at a p-value of less than 0.05. STATA version 16.1 was used for data clearing, validating and statistical analysis.

Results

Totally, 1,164 (97% response rate) participants were employed for analysis. Overall, 95.8% (95% CI: 94.4–96.7%) of the participants had at least one of the five risk factors of NCD. Furthermore, the proportion of participants that had all NCD risk factors was 0.3%. Among the participants, 47.5% were alcohol drinkers, 5.1% were current smokers, 35.5% were overweight, 49.1% exercise low physical activity, and 95% had less than five portions of fruits and vegetables intake per day. Higher risk factor scores were associated with those of advanced age (AIRR = 1.24; 95% CI: 1.01–1.53 in 35–44 age group and AIRR = 1.28; 95% CI: 1.01–1.62 in 45–54 age group), and the ones who are higher educational level (AIRR = 1.23; 95% CI: 1.07–1.43 for those who have completed secondary school and AIRR = 1.29; 95% CI: 1.11–1.50 for those who have completed college education).

Conclusion

The overwhelming majority (95.8%) of the participants had at least one risk factor for non-communicable diseases. The risk score of non-communicable diseases was higher among those with advanced age and who completed secondary and above levels of education. In a nutshell, the finding shows the need for lifestyle modification and comprehensive non-communicable diseases prevention programs for working adults in Eastern Ethiopia.

Effects of Disability Type on the Association between Age and Non-Communicable Disease Risk Factors among Elderly Persons with Disabilities in Shanghai, China

Little is known about differences in the association between age and risk factors of non-communicable diseases (NCDs), according to the disability type in Chinese elderly persons with disabilities. Thus, we examined the effects of these differences in elderly persons with disabilities in Shanghai, China. We evaluated four NCD risk factors (hypertension, hyperglycemia, hyperlipidemia, and overweight) using health data obtained from 20,471 elderly persons with disabilities in 2017. Logistic regression analyses explored differences in the association between age and NCD risk factors according to the disability types, after adjusting for sociodemographic characteristics. We observed significant differences in the association between age and NCD risk factors across disability types; a significant association was observed between older age and higher odds of hypertension (p < 0.001) among subjects with a physical disability. However, the prevalence of hypertension did not significantly differ by age in subjects with multiple disabilities. Interventions for elderly patients whose disabilities are more strongly affected by environmental factors should focus more on reduction of subjects’ barriers to activities through improvements in living and environmental adaptability for physical activities.

Association between Participation in Annual Physical Examinations and Risk Factors for Noncommunicable Diseases in Adults with Disabilities: Evidence from Shanghai, China

The relationships between regular participation in annual physical examinations and the risk factors for noncommunicable diseases (NCDs) among adults with disabilities remains unclear. To address this gap, we used data from 130,899 individuals with disabilities in Shanghai (2014–2016) and evaluated four risk factors for NCDs: hypertension, hyperglycemia, hyperlipidemia, and being overweight. Overall, 4540 individuals participated in annual physical examinations across all three years and 11,388 missed examinations in 2015 (group without regular participation). Chi-squared tests and binary logistic regression were used to assess differences in patient characteristics and explore correlations between variables. Significant differences in age (χ² = 102.620, p < 0.01), place of residence (χ² = 94.308, p < 0.01), educational level (χ² = 59.884, p < 0.01), marital status (χ² = 16.414, p < 0.01) and disability type (χ² = 56.499, p < 0.01) and severity (χ² = 45.464, p < 0.01) were found between those who participated in regular physical examinations and those who did not. Regular participation was associated with reduced incidences of hypertension (odds ratio 0.799, 95% confidence interval (CI): 0.733–0.871) and hyperlipidemia (0.347, 95% CI: 0.307–0.392), but not with the incidence of diabetes (1.049, 95% CI: 0.944–1.166) or being overweight (0.907, 95% CI: 0.812–1.014). Hence, regular participation in annual physical examinations had different associations with risk factors for NCDs.

Association between education and health outcomes among adults with disabilities: evidence from Shanghai, China

Background

Adults with disabilities often have worse health outcomes than do their peers without disabilities. While education is a key determinant of health, there is little research available on the health disparities across education levels among adults with disabilities in developing countries. We therefore examined the association between health outcomes and education among adults with disabilities in Shanghai, China.

Methods

We used the health examination records of 42,715 adults with disabilities in Shanghai in 2014. Five health outcomes, including two diseases (fatty liver and hemorrhoids) and three risk factors (overweight [body mass index ≥ 24]), high blood glucose, and high blood lipid), were evaluated. Descriptive statistics and Pearson’s chi-square test were used to assess differences in participants’ demographic and disability characteristics. Pearson’s chi-square test and Fisher’s exact test were conducted to compare the prevalence of each health outcome among the different education levels. Finally, logistic regression analyses were conducted to explore the association between education and health outcomes after adjusting for sociodemographic characteristics.

Results

People with an elementary school or lower degree had the highest prevalence of overweight (52.1%) and high blood glucose (20.8%), but the lowest prevalence of hemorrhoids (18.6%) and fatty liver (38.9%). We observed significant differences in the association between education and health outcomes across disability types. For example, in physically disabled adults, higher education was related to higher odds of hemorrhoids (p < 0.001); however, there were no significant disparities in hemorrhoids across the education levels among adults with intellectual disabilities.

Discussion

Compared with people without disabilities, adults with disabilities in Shanghai have relatively poor health. The association between education and health outcomes differed according to the health condition and disability type. To reduce the prevalence rate of overweight and high blood glucose among people with disabilities, tailored health promotion initiatives must be developed for people with lower education levels. In contrast, specific attention should be paid to the prevention of hemorrhoids and fatty liver among more-educated people with disabilities. Our study provides important evidence for targeting educational groups with specific disability types for health promotion and intervention.