Comorbid Diabetes and Hypertension: Gender differences in prevalence and risk factors among adults (≥18 years) in an urban community in Kathmandu District in Nepal

V. Silvanus, Nishchal Dhakal, Niraj Shrestha, P. Kafle
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Abstract

Chronic diseases such as diabetes and hypertension are often influenced by biological, behavioural, environmental and social factors in women and men. This study aimed to identify the gender differences in prevalence and risk factors of comorbid diabetes and hypertension (CM) among adults aged 18 years and above in an urban community in Kathmandu, Nepal. A community-based cross-sectional analytical study was carried out in Gokarneshwor Ward 1, 2 and 3 among adults aged 18 years and above from September 2020- May 2023. Diabetes (DM) was defined as persons previously diagnosed by a physician and/or on anti-diabetic medication. Hypertension (HTN) was defined as a systolic blood pressure (SBP) of ≥140 mm Hg or a diastolic blood pressure (DBP) of ≥90 mm Hg or those who were diagnosed by a physician and/or receiving antihypertensive medication. Comorbidity (CM) was defined as persons with diabetes and hypertension. Information regarding socio-demographic data, behavioural and biological risk factors, anthropometric assessment and morbidity were obtained from adults aged 18 years and above using a Family study proforma. Multinomial logistic regression analyses with the referent category being persons with no diabetes or hypertension (NDH) were performed for three categories HTN vs NDH, DM vs NDH and CM vs NDH. Among 1538 adults with 776 women, overall prevalence of comorbidity was 5.3% (95% CI: 4.3 – 6.5); among men 6.1% and 5.5% among women. After adjusting for age, for both women and men, being currently married, alcohol use, family history of diabetes and generalized obesity were associated with comorbidity. However, these associations were more robust for men. Moreover, measures of central obesity were associated with comorbidity for men alone. Though alcohol use was higher among men, the association with comorbidity was more robust for women. Paradoxically, lower educational status among women and higher education among men were associated with higher odds of comorbidity. In conclusion, prevalence of comorbid diabetes and hypertension may differ marginally among men and women. Though comorbidity rates appear to be lower in Nepal in comparison to other countries in South Asia, the rising burden emphasizes the need for tailored public health interventions that address modifiable risk factors among men and women. Further research may help to elucidate the role of gender on cardiovascular risk and hard outcomes such as cardiovascular events and mortality among persons with comorbid diabetes and hypertension.
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合并糖尿病和高血压:尼泊尔加德满都地区城市社区成人(≥18 岁)患病率和风险因素的性别差异
糖尿病和高血压等慢性疾病通常受男女生理、行为、环境和社会因素的影响。本研究旨在确定尼泊尔加德满都一个城市社区中 18 岁及以上成年人合并糖尿病和高血压(CM)的患病率和风险因素的性别差异。2020 年 9 月至 2023 年 5 月期间,在 Gokarneshwor 病区 1、2 和 3 对 18 岁及以上成年人进行了一项基于社区的横断面分析研究。糖尿病(DM)的定义是先前经医生诊断和/或服用抗糖尿病药物的人。高血压(HTN)是指收缩压(SBP)≥140 毫米汞柱或舒张压(DBP)≥90 毫米汞柱,或经医生诊断和/或正在服用降压药者。合并症(CM)是指患有糖尿病和高血压的人。研究人员使用家庭研究表格从 18 岁及以上的成年人中获取了有关社会人口学数据、行为和生物风险因素、人体测量评估和发病率的信息。以无糖尿病或高血压(NDH)者为参照类别,对高血压 vs NDH、糖尿病 vs NDH 和中风 vs NDH 三个类别进行了多项式逻辑回归分析。在 1538 名成年人(其中有 776 名女性)中,合并症的总发病率为 5.3%(95% CI:4.3 - 6.5);男性为 6.1%,女性为 5.5%。在对年龄进行调整后,无论男女,已婚、饮酒、糖尿病家族史和全身肥胖都与合并症有关。不过,这些关联在男性中更为明显。此外,仅就男性而言,中心性肥胖与合并症有关。虽然男性酗酒的比例较高,但女性酗酒与合并症的关系更为密切。矛盾的是,女性受教育程度较低和男性受教育程度较高与较高的合并症几率相关。总之,糖尿病和高血压合并症的发病率在男性和女性之间可能略有不同。虽然与南亚其他国家相比,尼泊尔的并发症发病率似乎较低,但不断增加的负担强调了针对男性和女性中可改变的风险因素采取有针对性的公共卫生干预措施的必要性。进一步的研究可能有助于阐明性别对心血管风险的作用,以及对合并糖尿病和高血压患者的心血管事件和死亡率等严重后果的影响。
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