Association between socioeconomic status and prevalence of non-communicable diseases risk factors and comorbidities in Bangladesh: findings from a nationwide cross-sectional survey

Biswas, Tuhin; Townsend, Nick; Islam, Saimul; Islam, Rajibul; Gupta, Rajat Das; Das, Sumon Kumar; Mamun, Abdullah Al

doi:10.1136/bmjopen-2018-025538

Cited by 49 publications

(54 citation statements)

References 34 publications

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“…Physical check-ups were more likely to unearth multimorbidity in middle-aged and young-old participants, which suggests that younger people should take regular physical examinations. As demonstrated in numerous studies [ 16 , 17 , 18 ], exercise was a protective factor to avoid multimorbidity, but the effect was only significant for those over aged 75 in our study. A new finding is that daily teeth brushing could effectively attenuate multimorbidity for middle aged and young-old participants.…”

Section: Discussionsupporting

confidence: 47%

“…Numerous studies have explored the age, gender, place of residence, education, income level, and occupation as factors associated with multimorbidity [ 12 , 13 , 14 ]. Lifestyle factors, such as obesity, tobacco use, drinking and physical inactivity, and unhealthy diets, have also been identified as multimorbidity risk factors [ 1 , 15 , 16 , 17 , 18 ]. Most of these studies have focused on older adults, given the susceptibility of older people to multimorbidity [ 10 , 15 , 19 , 20 ], with global multimorbidity rates as high as 98% among older adults [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Health-Related Quality of Life and Health Service Use among Multimorbid Middle-Aged and Older-Aged Adults in China: A Cross-Sectional Study in Shandong Province

Zhao

Wang

Nicholas

et al. 2020

IJERPH

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(1) Background: The management of multiple chronic diseases challenges China’s health system, but current research has neglected how multimorbidity is associated with poor health-related quality of life (HRQOL) and high health service demands by middle-aged and older adults. (2) Methods: A cross-sectional study was conducted in Shandong province, China in 2018 across three age groups: Middle-aged (45 to 59 years), young-old (60 to 74 years), and old-old (75 or above years). The information about socio-economic, health-related behaviors, HRQOL, and health service utilization was collected via face-to-face structured questionnaires. The EQ-5D-3L instrument, comprising a health description system and a visual analog scale (VAS), was used to measure participants’ HRQOL, and χ2 tests and the one-way ANOVA test were used to analyze differences in socio-demographic factors and HRQOL among the different age groups. Logistic regression models estimated the associations between lifestyle factors, health service utilization, and multimorbidity across age groups. (3) Results: There were 17,867 adults aged 45 or above in our sample, with 9259 (51.82%) female and 65.60% living in rural areas. Compared with the middle-aged adults, the young-old and old-old were more likely to be single and to have a lower level of education and income, with the old-old having lower levels than the young-old (P < 0.001). We found that 2465 (13.80%) suffered multimorbidities of whom 75.21% were older persons (aged 60 or above). As age increased, both the mean values of EQ-5D utility and the VAS scale decreased, displaying an inverse trend to the increase in the number of chronic diseases (P < 0.05). Ex-smokers and physical check-ups for middle or young-old respondents and overweight/obesity for all participants (P < 0.05) were positively correlated with multimorbidity. Drinking within the past month for all participants (P < 0.001), and daily tooth-brushing for middle (P < 0.05) and young-old participants (P < 0.001), were negatively associated with multimorbidity. Multimorbidities increased service utilization including outpatient and inpatient visits and taking self-medicine; and the probability of health utilization was the lowest for the old-old multimorbid patients (P < 0.001). (4) Conclusions: The prevalence and decline in HRQOL of multimorbid middle-aged and older-aged people were severe in Shandong province. Old patients also faced limited access to health services. We recommend early prevention and intervention to address the prevalence of middle-aged and old-aged multimorbidity. Further, the government should set-up special treatment channels for multiple chronic disease sufferers, improve medical insurance policies for the older-aged groups, and set-up multiple chronic disease insurance to effectively alleviate the costs of medical utilization caused by economic pressure for outpatients and inpatients with chronic diseases.

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Section: Discussionsupporting

confidence: 47%

Section: Introductionmentioning

confidence: 99%

Health-Related Quality of Life and Health Service Use among Multimorbid Middle-Aged and Older-Aged Adults in China: A Cross-Sectional Study in Shandong Province

Zhao

Wang

Nicholas

et al. 2020

IJERPH

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“…Second, in this systematic review, we were unable to differentiate between the type 1 and type 2 diabetes; nonetheless, evidence shows that type 2 diabetes accounts for 90%-95% of all diabetes cases. 47 Third, we only considered univariable meta-regression analysis to test the significance of each covariate instead of multivariable meta-regression analyses. Multivariable meta-regression analyses might be a useful technique to take into account the variance due to diagnostic criteria for diabetes.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of diabetes and pre-diabetes in Bangladesh: a systematic review and meta-analysis

et al. 2020

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ObjectiveThe purpose of this paper is to perform a systematic review and meta-analysis in order to summarise the prevalence of diabetes and pre-diabetes and their associated risk factors in Bangladesh.DesignSystematic review and meta-analysis.ParticipantsGeneral population of Bangladesh.Data sourcesPubMed, Medline, Embase, Bangladesh Journals Online, Science Direct, Scopus, Cochrane Library and Web of Science were used to search for studies, published between 1st of January 1995 and 31st of August 2019, on the prevalence of diabetes and pre-diabetes and their associated risk factors in Bangladesh. Only articles published in the English language articles were considered. Two authors independently selected studies. The quality of the articles was also assessed.ResultsOut of 996 potentially relevant studies, 26 population-based studies, which together involved a total of 80 775 individuals, were included in the meta-analysis. The pooled prevalence of diabetes in the general population was 7.8% (95% CI: 6.4–9.3). In a sample of 56 452 individuals, the pooled prevalence of pre-diabetes was 10.1% (95% CI: 6.7–14.0; 17 studies). The univariable meta-regression analyses showed that the prevalence of diabetes is associated with the factors: the year of study, age of patients and presence of hypertension. The prevalence of diabetes was significantly higher in urban areas compared with rural areas, while there was no significant gender difference.ConclusionsThis meta-analysis suggests a relatively high prevalence of pre-diabetes and diabetes in Bangladesh, with a significant difference between rural and urban areas. The main factors of diabetes include urbanisation, increasing age, hypertension and time period. Further research is needed to identify strategies for early detecting, prevention and treatment of people with diabetes in the population.PROSPERO registration numberCRD42019148205.

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“…Participants rated the extent to which they have experienced symptoms over the previous week on a 4-point Likert scale ranging from 0 (did not apply to me at all) to 3 (applied to me very much, or most of the time). The cut-off scores for depressive symptoms were developed according to the DASS manual: normal (0-9), mild (10-13), moderate (14)(15)(16)(17)(18)(19)(20), severe (21)(22)(23)(24)(25)(26)(27), and extremely severe (≥28). Participants were considered to suffer from depressive disorders if they scored ≥ 10.…”

Section: Measurementsmentioning

confidence: 99%

Mediators of the association between low socioeconomic status and poor glycemic control among type 2 diabetics in Bangladesh

Rahman

Nakamura

Hasan

et al. 2020

Sci Rep

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in contrast to developed countries 8 , leisure time physical activity in Bangladesh 13 is more prevalent in the lower SES group. Thus, adverse health-related behaviors might mediate the relationship between low SES and poor glycemic control. Among the comorbid conditions, being overweight/obese was generally associated with an increased likelihood of poor glycemic control in type 2 diabetics 15. Studies also noted that comorbid conditions such as hypertension 16 and depressive symptoms 17 are correlated with poorer glycemic control. Besides, hypertension, obesity, and depressive symptoms often exhibit socioeconomic patterning 18,19 , low prevalence of hypertension and overweight/obesity 18 and high prevalence of depressive symptoms 19 were observed in the low SES group. Therefore, these comorbid conditions may potentially mediate the relationship between low SES and poor glycemic control. Apart from adverse-health related behaviors and comorbid conditions, non-adherence to essential health service-related practices including irregular scheduled visits to diabetes clinic, not practicing self-monitoring of blood glucose concentrations, and reliance on alternative medicine have been known to contribute to poor glycemic control 14,20-22. Several observational studies found that underuse of recommended preventive services associated with poor glycemic control 20,21. Studies also indicated that patients who were not self-monitored their blood glucose 14 and rely on alternative medicine 22 had higher odds of having poorly controlled blood glucose compared to those who self-monitored their blood glucose and do not rely on alternative medicine. Furthermore, these essential health service-related practices vary by SES. In comparison to the high-SES group, people in the low-SES group are more likely to use low-cost and often less-effective alternative medicines and to experience barriers in the timely use of health care services according to their need 23. Accordingly, non-adherence to essential health service-related practices has been proposed as potential mediators of the association between low SES and poor glycemic control. To our knowledge, there has been only a single study regarding to examine the mediators contributing to socioeconomic inequality in glycemic control 24 , which showed that avoidance coping during a stressful event related to their diabetes (eg, to give up trying to deal with the event or to refuse to believe it is happening) and depressive symptoms mediated the relationship between SES and glycemic control. However, the contributions of mediators relating low SES to poorer glycemic control may differ according to context, suggesting the need for research in different settings. To date, there have been no studies in developing countries to assess the mediators relating low SES to poorer glycemic control. Therefore, evidence on socioeconomic disparities in glycemic control and potential mediators to mitigate this relationship is required. This study was performed to examine potential modifiable factor...

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Association between socioeconomic status and prevalence of non-communicable diseases risk factors and comorbidities in Bangladesh: findings from a nationwide cross-sectional survey

Cited by 49 publications

References 34 publications

Health-Related Quality of Life and Health Service Use among Multimorbid Middle-Aged and Older-Aged Adults in China: A Cross-Sectional Study in Shandong Province

Health-Related Quality of Life and Health Service Use among Multimorbid Middle-Aged and Older-Aged Adults in China: A Cross-Sectional Study in Shandong Province

Prevalence of diabetes and pre-diabetes in Bangladesh: a systematic review and meta-analysis

Mediators of the association between low socioeconomic status and poor glycemic control among type 2 diabetics in Bangladesh

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