Patel Shivani A, Dhillon Preet K, Kondal Dimple, Jeemon Panniyammakal, Kahol Kashvi, Manimunda Sathya Prakash, Purty Anil J, Deshpande Ajit, Negi P C, Ladhani Sulaiman, Toteja Gurudayal Singh, Patel Vikram, Prabhakaran Dorairaj
Centre for Chronic Disease Control, Gurugram, Haryana, India.
Hubert Department of Global Health, Emory University, Atlanta, Georgia, United States of America.
PLoS Med. 2017 Sep 29;14(9):e1002395. doi: 10.1371/journal.pmed.1002395. eCollection 2017 Sep.
The household is a potentially important but understudied unit of analysis and intervention in chronic disease research. We sought to estimate the association between living with someone with a chronic condition and one's own chronic condition status.
We conducted a cross-sectional analysis of population-based household- and individual-level data collected in 4 socioculturally and geographically diverse settings across rural and urban India in 2013 and 2014. Of 10,703 adults ages 18 years and older with coresiding household members surveyed, data from 7,522 adults (mean age 39 years) in 2,574 households with complete covariate information were analyzed. The main outcome measures were diabetes (fasting plasma glucose ≥ 126 mg/dL or taking medication), common mental disorder (General Health Questionnaire score ≥ 12), hypertension (blood pressure ≥ 140/90 mmHg or taking medication), obesity (body mass index ≥ 30 kg/m2), and high cholesterol (total blood cholesterol ≥ 240 mg/dL or taking medication). Logistic regression with generalized estimating equations was used to model associations with adjustment for a participant's age, sex, education, marital status, religion, and study site. Inverse probability weighting was applied to account for missing data. We found that 44% of adults had 1 or more of the chronic conditions examined. Irrespective of familial relationship, adults who resided with another adult with any chronic condition had 29% higher adjusted relative odds of having 1 or more chronic conditions themselves (adjusted odds ratio [aOR] = 1.29; 95% confidence interval [95% CI] 1.10-1.50). We also observed positive statistically significant associations of diabetes, common mental disorder, and hypertension with any chronic condition (aORs ranging from 1.19 to 1.61) in the analysis of all coresiding household members. Associations, however, were stronger for concordance of certain chronic conditions among coresiding household members. Specifically, we observed positive statistically significant associations between living with another adult with diabetes (aOR = 1.60; 95% CI 1.23-2.07), common mental disorder (aOR = 2.69; 95% CI 2.12-3.42), or obesity (aOR = 1.82; 95% CI 1.33-2.50) and having the same condition. Among separate analyses of dyads of parents and their adult children and dyads of spouses, the concordance between the chronic disease status was striking. The associations between common mental disorder, hypertension, obesity, and high cholesterol in parents and those same conditions in their adult children were aOR = 2.20 (95% CI 1.28-3.77), 1.58 (95% CI 1.15-2.16), 4.99 (95% CI 2.71-9.20), and 2.57 (95% CI 1.15-5.73), respectively. The associations between diabetes and common mental disorder in husbands and those same conditions in their wives were aORs = 2.28 (95% CI 1.52-3.42) and 3.01 (95% CI 2.01-4.52), respectively. Relative odds were raised even across different chronic condition phenotypes; specifically, we observed positive statistically significant associations between hypertension and obesity in the total sample of all coresiding adults (aOR = 1.24; 95% CI 1.02-1.52), high cholesterol and diabetes in the adult-parent sample (aOR = 2.02; 95% CI 1.08-3.78), and hypertension and diabetes in the spousal sample (aOR = 1.51; 95% CI 1.05-2.17). Of all associations examined, only the relationship between hypertension and diabetes in the adult-parent dyads was statistically significantly negative (aOR = 0.62; 95% CI 0.40-0.94). Relatively small samples in the dyadic analysis and site-specific analysis call for caution in interpreting qualitative differences between associations among different dyad types and geographical locations. Because of the cross-sectional nature of the analysis, the findings do not provide information on the etiology of incident chronic conditions among household members.
We observed strong concordance of chronic conditions within coresiding adults across diverse settings in India. These data provide early evidence that a household-based approach to chronic disease research may advance public health strategies to prevent and control chronic conditions.
Clinical Trials Registry India CTRI/2013/10/004049; http://ctri.nic.in/Clinicaltrials/login.php.
家庭是慢性病研究中一个潜在重要但研究不足的分析和干预单位。我们试图估计与慢性病患者同住与自身慢性病状况之间的关联。
我们对2013年和2014年在印度农村和城市4个社会文化和地理环境不同的地区收集的基于人群的家庭和个人层面数据进行了横断面分析。在接受调查的10703名18岁及以上且有同住家庭成员的成年人中，分析了来自2574户家庭中7522名成年人（平均年龄39岁）的数据，这些数据具有完整的协变量信息。主要结局指标包括糖尿病（空腹血糖≥126mg/dL或正在服药）、常见精神障碍（一般健康问卷得分≥12）、高血压（血压≥140/90mmHg或正在服药）、肥胖（体重指数≥30kg/m²）和高胆固醇（总血胆固醇≥240mg/dL或正在服药）。使用广义估计方程的逻辑回归对参与者的年龄、性别、教育程度、婚姻状况、宗教信仰和研究地点进行调整后，对关联进行建模。采用逆概率加权法处理缺失数据。我们发现44%的成年人患有1种或更多所研究的慢性病。无论家庭关系如何，与患有任何慢性病的另一位成年人同住的成年人自身患1种或更多慢性病的调整后相对比值高29%（调整后的比值比[aOR]=1.29；95%置信区间[95%CI]为1.10 - 1.50）。在对所有同住家庭成员的分析中，我们还观察到糖尿病、常见精神障碍和高血压与任何慢性病之间存在统计学上显著的正相关（aOR范围为1.19至1.61）。然而，同住家庭成员中某些慢性病的一致性关联更强。具体而言，我们观察到与患有糖尿病（aOR = 1.60；95%CI为1.23 - 2.07）、常见精神障碍（aOR = 2.69；95%CI为2.12 - 3.42）或肥胖（aOR = 1.82；95%CI为1.33 - 2.50）的另一位成年人同住与患有相同疾病之间存在统计学上显著的正相关。在对父母及其成年子女的二元组和配偶二元组的单独分析中，慢性病状况之间的一致性非常显著。父母中的常见精神障碍、高血压、肥胖和高胆固醇与成年子女中相同疾病之间的关联分别为aOR = 2.20（95%CI为1.28 - 3.77）、1.58（95%CI为1.15 - 2.16）'4.99（95%CI为2.71 - 9.20）和2.57（95%CI为1.15 - 5.73）。丈夫中的糖尿病和常见精神障碍与妻子中相同疾病之间的关联分别为aOR = 2.28（95%CI为1.52 - 3.42）和3.01（95%CI为2.01 - 4.52）。即使在不同的慢性病表型之间，相对比值也有所升高；具体而言，在所有同住成年人的总样本中，我们观察到高血压与肥胖之间存在统计学上显著的正相关（aOR = 1.24；95%CI为1.02 - 1.52），在成年父母样本中高胆固醇与糖尿病之间存在正相关（aOR = 2.02；95%CI为1.08 - 3.78），在配偶样本中高血压与糖尿病之间存在正相关（aOR = 1.51；95%CI为1.05 - 2.17）。在所有检验的关联中，只有成年父母二元组中高血压与糖尿病之间的关系在统计学上显著为负（aOR = 0.62；95%CI为0.40 - 0.94）。二元组分析和特定地点分析中的样本相对较小，因此在解释不同二元组类型和地理位置之间关联的定性差异时需谨慎。由于分析的横断面性质，这些发现并未提供关于家庭成员中慢性疾病发生病因的信息。
我们观察到在印度不同环境中同住成年人之间慢性病存在很强的一致性。这些数据提供了早期证据，表明基于家庭的慢性病研究方法可能会推进预防和控制慢性病的公共卫生策略。
印度临床试验注册中心CTRI/2013/10/004049；http://ctri.nic.in/Clinicaltrials/login.php。
