Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, Florida, United States of America.
Department of Statistics, University of Florida, Gainesville, Florida, United States of America.
PLoS One. 2021 Dec 2;16(12):e0259507. doi: 10.1371/journal.pone.0259507. eCollection 2021.
Bangladesh is one of the countries where the prevalence of non-communicable diseases (NCDs) such as hypertension is rising due to rising living standards, sedentary lifestyles, and epidemiological transition. Among the NCDs, hypertension is a major risk factor for CVD, accounting for half of all coronary heart disease worldwide. However, detailed research in this area has been limited in Bangladesh. The objective of the study was to estimate changes in the prevalence and risk factors of hypertension among Bangladeshi adult population. The study also sought to identify socioeconomic status-related inequality of hypertension prevalence in Bangladesh.
Cross-sectional analysis was conducted using nationally representative two waves of the Bangladesh Demographic and Health Survey (BDHS) in 2011 and 2017-18. Survey participants were adults 18 years or older- which included detailed biomarker and anthropometric measurements of 23539 participants. The change in prevalence of hypertension was estimated, and adjusted odds ratios were obtained using multivariable survey logistic regression models. Further, Wagstaff decomposition method was also used to analyze the relative contributions of factors to hypertension.
From 2011 to 2018, the hypertension prevalence among adults aged ≥35 years increased from 25.84% to 39.40% (p<0.001), with the largest relative increase (97%) among obese individuals. The prevalence among women remained higher than men whereas the relative increase among men and women were 75% and 39%, respectively. Regression analysis identified age and BMI as the independent risk factors of hypertension. Other risk factors of hypertension were sex, marital status, education, geographic region, wealth index, and diabetes status in both survey years. Female adults had significantly higher hypertension risk in both survey years in the overall analysis in, however, in the subgroup analysis, the gender difference in hypertension risk was not significant in rural 2011 and urban 2018 samples. Decomposition analysis revealed that the contributions of socio-economic status related inequality of hypertension in 2011 were46.58% and 20.85% for wealth index and BMI, respectively. However, the contributions of wealth index and BMI have shifted to 12.60% and 55.29%, respectively in 2018.
The prevalence of hypertension among Bangladeshi adults has increased significantly, and there is no subgroup where it is decreasing. Population-level approaches directed at high-risk groups (overweight, obese) should be implemented thoroughly. We underscore prevention strategies by following strong collaboration with stakeholders in the health system of the country to adopt healthy lifestyle choices.
由于生活水平提高、生活方式久坐不动以及流行病学转变，孟加拉国等国家的非传染性疾病（NCD）患病率不断上升，如高血压。在这些 NCD 中，高血压是心血管疾病（CVD）的主要危险因素，占全球所有冠心病的一半。然而，该领域的详细研究在孟加拉国受到限制。本研究旨在估计孟加拉国成年人口中高血压患病率和危险因素的变化。该研究还旨在确定高血压在孟加拉国的社会经济地位相关不平等。
使用 2011 年和 2017-18 年两次全国代表性的孟加拉国人口与健康调查（BDHS）进行横断面分析。调查参与者为 18 岁或以上的成年人-其中包括 23539 名参与者的详细生物标志物和人体测量学测量。使用多变量调查逻辑回归模型估计高血压患病率的变化，并获得调整后的优势比。此外，还使用 Wagstaff 分解方法分析了各因素对高血压的相对贡献。
从 2011 年到 2018 年，年龄在 35 岁及以上的成年人中高血压患病率从 25.84%上升到 39.40%（p<0.001），肥胖者的相对增幅最大（97%）。女性的患病率仍然高于男性，而男性和女性的相对增幅分别为 75%和 39%。回归分析确定年龄和 BMI 是高血压的独立危险因素。其他高血压危险因素是性别、婚姻状况、教育、地理区域、财富指数和糖尿病状况，这两个调查年份均存在这些因素。在整体分析中，女性成年人在两个调查年份的高血压风险均显著更高，然而，在亚组分析中，农村 2011 年和城市 2018 年样本中，性别与高血压风险之间的差异并不显著。分解分析显示，2011 年财富指数和 BMI 导致高血压的社会经济地位相关不平等的贡献分别为 46.58%和 20.85%。然而，在 2018 年，财富指数和 BMI 的贡献分别转变为 12.60%和 55.29%。
孟加拉国成年人高血压的患病率显著增加，没有任何亚组的患病率在下降。应全面实施针对高风险群体（超重、肥胖）的人群水平方法。我们强调通过与该国卫生系统的利益相关者密切合作，采取健康的生活方式选择，来实施预防策略。
