Multilevel examination of diabetes in modernising China: what elements of urbanisation are most associated with diabetes?

Attard, Samantha M.; Herring, Amy H.; Mayer‐Davis, Elizabeth J.; Popkin, Barry M.; Meigs, James B.; Gordon‐Larsen, Penny

doi:10.1007/s00125-012-2697-8

Cited by 41 publications

(37 citation statements)

References 33 publications

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“…[20, 30–32] However, recent research suggest increasing risk of CVD in less urban areas. [31, 33] Our study contributes to this body of evidence and suggests the need for expansion of CVD prevention, screening, and treatment to rural areas and to young adults, who are not typically seen as ‘at high risk’ of hypertension or CVD.…”

Section: Discussionmentioning

confidence: 75%

Associations between age, cohort, and urbanization with SBP and DBP in China

Attard¹,

Herring

Zhang

et al. 2015

Journal of Hypertension

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Objective Little is known about whether large-scale environmental changes, such as those seen with urbanization, are differentially associated with systolic versus diastolic blood pressure, and whether those changes vary by birth cohort. Methods We used data from the China Health and Nutrition Survey, a population-based cohort study of Chinese adults (n=18,976; ages 18–70y) seen a maximum of 7 times over 1991–2009. We used hierarchical multivariable linear models to simultaneously estimate systolic and diastolic blood pressure as correlated outcomes over time, accounting for their physiologic, time-varying correlation. Main exposure variables were urbanicity, age, and birth cohort. Over 18 years of modernization, median systolic and diastolic blood pressure increased by 10 and 7 mm Hg, respectively. Results Our hierarchical model results suggest greater temporal increases in systolic and particularly diastolic blood pressure at lower versus higher urbanicity. At the same chronological age, for a 10-year difference in birth cohort (i.e., born in 1980s versus 1970s) the adjusted mean diastolic blood pressure was ~3mm Hg higher for the later birth cohort (p<0.001). Pulse pressure (calculated as model-predicted systolic minus diastolic blood pressure) was also higher at low versus high urbanicity. Conclusions These results suggest increased susceptibility of diastolic blood pressure (and thus peripheral vascular resistance) to environmental change, particularly in younger Chinese adults. Because diastolic blood pressure more strongly predicts cardiovascular disease risk in younger adulthood, hypertension-related health burden in China may increase over time.

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Section: Discussionmentioning

confidence: 75%

Associations between age, cohort, and urbanization with SBP and DBP in China

Attard¹,

Herring

Zhang

et al. 2015

Journal of Hypertension

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“…No large‐scale study has measured these dietary factors so precisely and thus allowed longitudinal analyses of time to hypertension, among other outcomes . Second is the effect of urbanicity and many long‐term behaviours in relation to cardiometabolic outcomes , where many forthcoming or recent CHNS studies promise to add to the literature.…”

Section: Other Cardiometabolic Risk Factorsmentioning

confidence: 99%

Synthesis and implications: China's nutrition transition in the context of changes across other low‐ and middle‐income countries

2013

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The China Health and Nutrition Survey (CHNS) is important for its insights into current and future diet, physical activity, and obesity-related changes in China and for understanding underlying processes common across low- and middle-income countries (LMICs). While China modernized later than Latin American countries, many changes seen in China echo those in Latin America and in other LMICs. In general changes in physical activity and diet behaviors in China have occurred at a faster pace relative to other LMICs. Modernization of the overall Chinese food system has lagged behind most other LMICs, yet the now-rapid changes in the Chinese food system are similar to what has been seen in other LMICs. Further, there is variation in these changes across social and geographic space. The incidence of obesity and noncommunicable diseases has increased as the major health burden has shifted toward the poor. This paper examines changes in China and addresses the literature and issues that link these changes with those in other LMICs. In many ways the detailed 20-year CHNS, with nine repeated measures, provides a remarkable window through which to understand nutrition-related changes in other LMICs.

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“…An evaluation in China, which saw a greater than twofold increase in diabetes prevalence from 3% in 1994 to 7–10% in 2008, found that diabetes was approximately twice as prevalent in high versus low urbanized areas, even after accounting for factors such as community, province, age, sex, and household income. Modern markets, as described by the number of grocery stores, cafes, internet cafes, restaurants, mobile eateries, fast food restaurants, and ice cream parlors in the community, were positively associated with diabetes prevalence, as were community-level factors such as transportation infrastructure (presence and higher number of paved vs. gravel or dirt roads and bus and/or train stations in the community) and communications (percentage of households with a television, computer, or cell phone and presence of a cinema, newspaper, and telephone service in the community) (36). Similar associations between urbanization and cardiovascular risk factors and diabetes have been documented in other countries (37–40).…”

Section: Socioecological Influences In Obesity and Diabetes Riskmentioning

confidence: 99%