Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe and Karonga, Malawi.
Institute for Medical Microbiology and Illnesses, Philipps University of Marburg, Marburg, Germany.
Int J Epidemiol. 2019 Dec 1;48(6):1850-1862. doi: 10.1093/ije/dyz198.
The extent to which rural-to-urban migration affects risk for cardiometabolic diseases (CMD) in Africa is not well understood. We investigated prevalence and risk for obesity, diabetes, hypertension and precursor conditions by migration status.
In a cross-sectional survey in Malawi (February 2013-March 2017), 13 903 rural, 9929 rural-to-urban migrant and 6741 urban residents (≥18 years old) participated. We interviewed participants, measured blood pressure and collected anthropometric data and fasting blood samples to estimate population prevalences and odds ratios, using negative binomial regression, for CMD, by migration status. In a sub-cohort of 131 rural-urban siblings-sets, migration-associated CMD risk was explored using conditional Poisson regression.
In rural, rural-to-urban migrant and urban residents, prevalence estimates were; 8.9, 20.9 and 15.2% in men and 25.4, 43.9 and 39.3% in women for overweight/obesity; 1.4, 2.9 and 1.9% in men and 1.5, 2.8 and 1.7% in women for diabetes; and 13.4, 18.8 and 12.2% in men and 13.7, 15.8 and 10.2% in women for hypertension. Rural-to-urban migrants had the greatest risk for hypertension (adjusted relative risk for men 1.18; 95% confidence interval 1.04-1.34 and women 1.17: 95% confidence interval 1.05-1.29) and were the most screened, diagnosed and treated for CMD, compared with urban residents. Within sibling sets, rural-to-urban migrant siblings had a higher risk for overweight and pre-hypertension, with no evidence for differences by duration of stay.
Rural-to-urban migration is associated with increased CMD risk in Malawi. In a poor country experiencing rapid urbanization, interventions for the prevention and management of CMD, which reach migrant populations, are needed.
农村向城市移民对非洲心血管代谢疾病（CMD）风险的影响尚不清楚。我们通过移民身份调查了肥胖、糖尿病、高血压和前体疾病的患病率和风险。
在马拉维的一项横断面调查中（2013 年 2 月至 2017 年 3 月），有 13903 名农村居民、9929 名农村到城市的移民和 6741 名城市居民（≥18 岁）参与了研究。我们对参与者进行了访谈，测量了血压，并收集了人体测量数据和空腹血样，使用负二项回归估计 CMD 的人群患病率和比值比，按移民身份进行分析。在一个由 131 个农村-城市兄弟姐妹对组成的子队列中，使用条件泊松回归探索了与移民相关的 CMD 风险。
在农村、农村到城市的移民和城市居民中，超重/肥胖的患病率估计值分别为男性 8.9%、20.9%和 15.2%，女性 25.4%、43.9%和 39.3%；男性 1.4%、2.9%和 1.9%，女性 1.5%、2.8%和 1.7%为糖尿病；男性 13.4%、18.8%和 12.2%，女性 13.7%、15.8%和 10.2%为高血压。与城市居民相比，农村到城市的移民患高血压的风险最高（男性调整后的相对风险 1.18；95%置信区间 1.04-1.34，女性 1.17：95%置信区间 1.05-1.29），且筛查、诊断和治疗 CMD 的人数最多。在兄弟姐妹对中，农村到城市的移民兄弟姐妹超重和高血压前期的风险更高，但停留时间的差异没有证据。
农村向城市移民与马拉维 CMD 风险增加有关。在一个快速城市化的贫穷国家，需要针对移民人口的 CMD 预防和管理干预措施。
