Ramalivhana Fhatuwani W, Veldsman Tamrin, Moss Sarah J
Physical Activity, Sport, and Recreation Research Focus Area (PhASRec), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.
School of Health and Medical Sciences, University of Southern Queensland, Ipswich, Australia.
BMC Public Health. 2024 Jun 12;24(1):1580. doi: 10.1186/s12889-024-18964-2.
Globally, disparities between non-communicable disease (NCD) risk factors, functional performance, and health-related quality of life (HRQoL) exist in people living in rural and low-resourced urban settings. Evidence of these health differences determined with objective NCD risk factors and functional performance measurements in South Africa, is scarce. Therefore, the study aimed to determine the differences in NCD risk factors, functional performance and HRQoL between rural and low-resourced urban areas.
The study recruited 311 adults (35-80 years) presenting with at least one NCD risk factor from low-resourced urban- (n = 183) and rural (n = 128) communities. Objective measurements of physical activity (PA) by means of combined heart rate and accelerometery, body composition employing skinfolds, peripheral lipid and glucose concentrations, blood pressure, functional performance indicators (handgrip, single leg stand, sit-to-stand, timed-up-and-go speed, predicted peak VO max); and HRQoL were measured according to standard procedures. Independent t-tests, Mann-Whitney U, and chi-square tests were performed to determine differences between the variables of low-resourced urban and rural settings.
The participants from the low-resourced urban setting were significantly older than the rural residents (59.1 ± 10.7 years vs. 52.8 ± 11.3 years; p = 0.001). NCD risk factors were significantly more prevalent in the low-resourced urban participants compared to rural participants, in particular for elevated systolic (85.8% vs. 62.5%; p = 0.001), and diastolic blood pressure (88.5% vs. 65.6%; p = 0.001), physical inactivity (95.9% vs. 87.7%; p = 0.026), increased cholesterol concentrations (22.1% vs. 8.7%; p = 0.002), and increased waist circumference (61.9% vs. 49.2%; p = 0.027). Low-resourced urban residents presented with a higher average body fat percentage (27.69% ± 7.65% vs. 12.23% ± 4.67%; p < 0.001), and lower moderate to vigorous PA levels (37.19 ± 49.55 [95% CI = 29.12-45.27] vs. 62.92 ± 60.43 min/week [95% CI = 47.95-77.90]; p = 0.003) compared to rural residents. Rural residents showed significantly better functional performance, including peak VO (23.99 ± 9.89 vs. 16.95 ± 7.64 ml/min/kg; p = 0.001) and single leg stand (right leg: 44.96 ± 18.47 vs. 20.87 ± 19.18 s; p = 0.001) as well as higher HRQoL for the physical (51.06 ± 8.14% vs. 45.62 ± 11.13%; p < 0.001) and mental (54.75 ± 8.24% vs. 48.91 ± 12.27%; p < 0.001) component scores compared to participants from the low-resourced urban areas.
NCD risk factors, functional performance, and HRQoL significantly differ in rural communities compared to low-resourced urban communities in South Africa. Urban areas' most prevalent risk factors were elevated blood pressure, physical inactivity, and increased waist circumference. Participants from rural areas demonstrated significantly better functional performance, such as fitness and balance. HRQoL was better in rural settings than in urban settings. Future intervention programmes should be tailored for specific settings.
在全球范围内，生活在农村和资源匮乏城市地区的人群在非传染性疾病（NCD）风险因素、功能表现和健康相关生活质量（HRQoL）方面存在差异。在南非，通过客观的非传染性疾病风险因素和功能表现测量来确定这些健康差异的证据很少。因此，本研究旨在确定农村和资源匮乏城市地区在非传染性疾病风险因素、功能表现和健康相关生活质量方面的差异。
该研究招募了311名成年人（35 - 80岁），他们来自资源匮乏的城市社区（n = 183）和农村社区（n = 128），且至少有一种非传染性疾病风险因素。通过心率和加速度计联合测量身体活动（PA），采用皮褶厚度测量身体成分，测量外周血脂和血糖浓度、血压、功能表现指标（握力、单腿站立、从坐到站、定时起立行走速度、预测的最大摄氧量峰值VO max）；并按照标准程序测量健康相关生活质量。进行独立t检验、曼 - 惠特尼U检验和卡方检验，以确定资源匮乏城市和农村地区变量之间的差异。
资源匮乏城市地区的参与者比农村居民年龄显著更大（59.1±10.7岁 vs. 52.8±11.3岁；p = 0.001）。与农村参与者相比，非传染性疾病风险因素在资源匮乏城市参与者中更为普遍，特别是收缩压升高（85.8% vs. 62.5%；p = 0.001）、舒张压升高（88.5% vs. 65.6%；p = 0.001）、身体活动不足（95.9% vs. 87.7%；p = 0.026）、胆固醇浓度升高（22.1% vs. 8.7%；p = 0.002）以及腰围增加（61.9% vs. 49.2%；p = 0.027）。与农村居民相比，资源匮乏城市居民的平均体脂百分比更高（27.69%±7.65% vs. 12.23%±4.67%；p < 0.001），中度至剧烈身体活动水平更低（37.19±49.55[95%CI = 29.12 - 45.27] vs. 62.92±60.43分钟/周[95%CI = 47.95 - 77.90]；p = 0.003）。农村居民的功能表现明显更好，包括最大摄氧量峰值（23.99±9.89 vs. 16.95±7.64毫升/分钟/千克；p = 0.001）和单腿站立（右腿：44.96±18.47 vs. 20.87±19.18秒；p = 0.001），并且在身体（51.06±8.14% vs. 45.62±11.13%；p < 0.001）和心理（54.75±8.24% vs. 48.91±12.27%；p < 0.001）分量得分方面的健康相关生活质量高于资源匮乏城市地区的参与者。
与南非资源匮乏的城市社区相比，农村社区在非传染性疾病风险因素、功能表现和健康相关生活质量方面存在显著差异。城市地区最普遍的风险因素是血压升高、身体活动不足和腰围增加。农村地区的参与者在功能表现方面明显更好，如身体素质和平衡能力。农村地区的健康相关生活质量优于城市地区。未来的干预计划应针对特定环境进行定制。
