Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Banjul, The Gambia.
International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK.
Lancet Glob Health. 2024 Jan;12(1):e55-e65. doi: 10.1016/S2214-109X(23)00508-9.
As countries progress through economic and demographic transition, chronic non-communicable diseases (NCDs) overtake a previous burden of infectious diseases. We investigated the prevalence of hypertension, diabetes, obesity, and multimorbidity in older adults in The Gambia.
We embedded a survey on NCDs into the nationally representative 2019 Gambia National Eye Health Survey of adults aged 35 years or older. We measured anthropometrics, capillary blood glucose, and blood pressure together with sociodemographic information, personal and family health history, and information on smoking and alcohol consumption. Hypertension was defined as systolic blood pressure of 140 mmHg or more, diastolic blood pressure of 90 mmHg or more, or receiving treatment for hypertension. Diabetes was defined as fasting capillary blood glucose of 7 mmol/L or more, random blood glucose of 11·1mmol/L or more, or previous diagnosis or treatment for diabetes. Overweight was defined as BMI of 25-29·9 kg/m and obesity as 30 kg/m or more. Multimorbidity was defined as the coexistence of two or more conditions. We calculated weighted crude and adjusted estimates for each outcome by sex, residence, and selected sociodemographic factors.
We analysed data from 9188 participants (5039 [54·8%] from urban areas, 6478 [70·5%] women). The prevalence of hypertension was 47·0%; 2259 (49·3%) women, 2052 (44·7%) men. The prevalence increased with age, increasing from 30% in those aged 35-45 years to over 75% in those aged 75 years and older. Overweight and obesity increased the odds of hypertension, and underweight reduced the odds. The prevalence of diabetes was 6·3% (322 [7·0%] women, 255 [5·6%] men), increasing from 3·8% in those aged 35-44 years to 9·1% in those aged 65-75 years, and then declining. Diabetes was much more common among urban residents, especially in women (peaking at 13% by age 65 years). Diabetes was strongly associated with BMI and wealth index. The prevalence of obesity was 12·0% and was notably higher in women than men (880 [20·2%] vs 170 [3·9%]). Multimorbidity was present in 932 (10·7%), and was more common in women than men (694 [15·9] vs 238 [5·5]). The prevalence of smoking was 9·7%; 5 (0·1%) women, 889 (19·3%) men. Alcohol consumption in the past year was negligible.
We have documented high levels of NCDs and associated risk factors in Gambian adults. This presents a major stress on the country's fragile health system that requires an urgent, concerted, and targeted mutisectoral strategy.
The Queen Elizabeth Diamond Jubilee Trust and Wellcome Trust.
随着国家在经济和人口方面的转型，非传染性疾病（NCDs）逐渐取代了之前的传染病负担。我们调查了冈比亚老年人中高血压、糖尿病、肥胖和多种疾病的流行情况。
我们将 NCD 调查嵌入到全国代表性的 2019 年冈比亚国家眼健康调查中，调查对象为 35 岁及以上的成年人。我们测量了人体测量学、毛细血管血糖和血压，以及社会人口学信息、个人和家庭健康史以及吸烟和饮酒信息。高血压定义为收缩压 140mmHg 或以上、舒张压 90mmHg 或以上，或正在接受高血压治疗。糖尿病定义为空腹毛细血管血糖 7mmol/L 或以上、随机血糖 11.1mmol/L 或以上，或之前诊断或治疗过糖尿病。超重定义为 BMI 为 25-29.9kg/m，肥胖定义为 BMI 为 30kg/m 或以上。多种疾病的定义为同时存在两种或两种以上的疾病。我们按性别、居住地和选定的社会人口学因素计算了每种结局的加权粗估计值和调整估计值。
我们分析了 9188 名参与者的数据（5039 名来自城市地区，6478 名女性）。高血压的患病率为 47.0%；2259 名女性（49.3%），2052 名男性（44.7%）。患病率随年龄增长而增加，从 35-45 岁人群的 30%增加到 75 岁及以上人群的 75%以上。超重和肥胖增加了高血压的几率，而体重不足则降低了高血压的几率。糖尿病的患病率为 6.3%（322 名女性，7.0%；255 名男性，5.6%），从 35-44 岁人群的 3.8%增加到 65-75 岁人群的 9.1%，然后下降。糖尿病在城市居民中更为常见，尤其是在女性中（65 岁时达到 13%的峰值）。糖尿病与 BMI 和财富指数密切相关。肥胖的患病率为 12.0%，女性明显高于男性（880 名，20.2%；170 名，3.9%）。多种疾病的患病率为 10.7%，女性多于男性（694 名，15.9%；238 名，5.5%）。吸烟率为 9.7%；5 名女性（0.1%），889 名男性（19.3%）。过去一年饮酒的情况可忽略不计。
我们记录了冈比亚成年人中 NCD 及其相关风险因素的高发病率。这对该国脆弱的卫生系统造成了重大压力，需要采取紧急、协调和有针对性的多部门战略。
伊丽莎白女王钻石禧年信托基金和惠康信托基金。
