Ahmmed Foyez, Hossain Md Jamal, Khan Md Tareq Ferdous, Manik Muhammad Mahabub Rahaman, Shahriar Saimon, Nandi Dulal Chandra, Hussain Md Parvej
Department of Statistics Comilla University Cumilla Bangladesh.
Department of Biostatistics & Data Science University of Kansas Medical Center Kansas City Kansas USA.
Health Sci Rep. 2024 Apr 23;7(4):e2063. doi: 10.1002/hsr2.2063. eCollection 2024 Apr.
Non-communicable diseases such as hypertension and diabetes are matters of huge concern worldwide, with an increasing trend in prevalence over the previous decade. First of all, this study aimed to evaluate the association between economic status (ES) and body mass index (BMI), ES and comorbidity of hypertension and diabetes, and BMI and comorbidity independently. Second, it explored the mediating role of BMI in the association between ES and comorbidity of hypertension and diabetes. Finally, it investigated whether the mediating effect differs with the place of residence, gender, and education levels.
A total of 11,291 complete cases from the Bangladesh demographic and health survey 2017-18 were utilized for this study. Survey-based binary logistic regression or multiple logistic regression was used to find the association among outcome, exposure, and mediator variables, and a counterfactual framework-based weighting approach was utilized for mediation analysis.
Middle-income (adjusted odds ratio [AOR]: 1.696, 95% confidence interval [CI]: 1.219, 2.360) and rich (AOR: 2.770, CI: 2.054, 3.736) respondents were more likely to have comorbidity of hypertension and diabetes compared to the poor. The odds of comorbidity increased with the increase in BMI. A positive association was observed between ES and BMI. A significant mediating role of BMI in the association between ES and comorbidity was found. We observed that 19.85% (95% CI: 11.50%, 49.6%) and 20.35% (95% CI: 14.9%, 29.3%) of total effect was mediated by BMI for middle and rich respondents, respectively, compared to the poor.
The mediating role of BMI was greater for female, no or primary educated respondents, and respondents from rural areas. Therefore, the study will facilitate policymakers of Bangladesh and other countries with a similar set-up to decide on health policies regarding hypertension and diabetes.
高血压和糖尿病等非传染性疾病是全球极为关注的问题，在过去十年中患病率呈上升趋势。首先，本研究旨在分别评估经济状况（ES）与体重指数（BMI）之间的关联、ES与高血压和糖尿病合并症之间的关联以及BMI与合并症之间的关联。其次，探讨BMI在ES与高血压和糖尿病合并症关联中的中介作用。最后，研究中介效应是否因居住地点、性别和教育水平而有所不同。
本研究使用了2017 - 18年孟加拉国人口与健康调查中的11291例完整病例。基于调查的二元逻辑回归或多元逻辑回归用于找出结局、暴露和中介变量之间的关联，并采用基于反事实框架的加权方法进行中介分析。
与贫困受访者相比，中等收入（调整后的优势比[AOR]：1.696，95%置信区间[CI]：1.219, 2.360）和富裕（AOR：2.770，CI：2.054, 3.736）受访者患高血压和糖尿病合并症的可能性更高。合并症的几率随着BMI的增加而增加。观察到ES与BMI之间存在正相关。发现BMI在ES与合并症的关联中具有显著的中介作用。我们观察到，与贫困受访者相比，中等收入和富裕受访者的总效应分别有19.85%（95% CI：11.50%，49.6%）和20.35%（95% CI：14.9%，29.3%）由BMI介导。
BMI的中介作用在女性、未受过教育或仅接受过小学教育的受访者以及农村地区的受访者中更大。因此，该研究将有助于孟加拉国和其他情况类似的国家的政策制定者制定有关高血压和糖尿病的卫生政策。
