Authored by Bhuyan KC*
Abstract
The analytical results presented here were the outcome of the information collected from 960 adults of ages 18 years and aboveliving in both urban and rural areas. These adults were investigated by some doctors and nurses from and nearby their working places using quota sampling plan with an objective of covering around 70percent diabetic adults so that sufficient obese and hypertension patients were included in the sample. Out of 960 adults 15.1 percent were suffering from hypertension. Among these adults of hypertension, 16.5 percent were obese. The level of obesity and prevalence of hypertension were significantly associated. Thus it was decided to identify the socioeconomic variables responsible for the sufferings of the adults simultaneously from obesity and hypertension. It was evident from the analytical results that age, marital status, physical inactivity, and involvement in sedentary activities were the responsible factors for the simultaneous sufferings of obesity and hypertension. These information were noted from the test of independence of obesity hypertension and socioeconomic variables. Besides these variables, gender, occupation, value of body mass index, and use of can food were also identified as the responsible factors for prevalence of obesity hypertension among the adults. These letter group of variables were identified by discriminant analysis.
Keywords: Obesity; Hypertension; Socioeconomic variables; Odds ratio; Standard error of ln(odds ratio); Discriminant analysis; Pooled within group correlation
Introduction
Hypertension is one of the components of non-communicable diseases (NCDs). It is the primary risk factor for cardiovascular disease, including stroke, heart failure, heart attack and aneurysm. The causes of hypertension are diabetes, kidney diseases, nerve damage, overactive thyroid gland, sleep apnoea, pregnancy, obesity, etc. The problem of hypertension is more prevalent among elderly people worldwide and by 2025 the majority of the elderly people will reside in developing countries [1-3]. The disease is rapidly emerging in developing countries [4,5].
Obesity is also prevalent among elderly people and it is influenced by many socioeconomic factors [6-11]. Again, obesity and hypertension are associated and both are in increasing trend among children also [12,13]. Hypertension is highly prevalent among overweight and obese primary care patients [14,15]. It is also prevalent among middle aged men and women [16]. Thus, age can be considered as a responsible factor for hypertension. As hypertension is one type of NCDs, it has many risk factors. Some of these risk factors are socioeconomic variables. Prevalence of hypertension, awareness, and risk factors were previously studied by some authors [16-21]. Again, socioeconomic variables are responsible for all types of non-communicable diseases and it was reported in both home and abroad [22–26]. In a separate study, it was reported that obesity and NCDs were significantly associated [27].
The above discussion indicted that obesity and hypertension were associated. Due to this association a question naturally arises which of the socioeconomic variables are more responsible for the prevalence of both the diseases simultaneously among elderly people of Bangladesh. Thus, the objective of this study was to identify the responsible factors for the prevalence of the disease.
Methodology
The source of data for the present analysis was the collected information from adults of ages 18 years and above residing in both urban and rural areas of Bangladesh. The investigated adults were 960. They were available for investigation nearby the working places of some doctors and nurses when they were doing their Master of Public Health degree in American International University- Bangladesh during the academic session 2017 – 18 . These adults were investigated by quota sampling method to cover around 70% diabetic patients [26]. The objective to cover this amount of diabetic patients was to ensure a good amount of obese hypertension people. For comparative study a good number of normal subjects were also investigated. Finally, 960 adults were interviewed and data were recorded through a pre-designed and pre-tested questionnaire.
The questionnaire contained different questions related to different socioeconomic variables of the respondents and of the families. The main questions for families were related to the monthly family income and monthly family expenditure. The questions for the diabetic adults were related to the duration of disease, disease related health hazard, i.e. eye problem, kidney problem, heart problem, blood pressure, blood sugar, treatment stage of disease, admission into hospital, etc. Beside these, the other questions were related to personal habit, viz. food habit, working habit, physical activity, utilization of time, etc. The collected personal information were residence, religion, marital status, age, height , weight, education, and occupation. Some of the above mentioned variables were qualitative and some are quantitative in nature. For analytical purpose all the variables were measured in nominal scale by assigning numbers. Height and weight were used to measure the level of obesity and level of obesity was measured by the value of BMI, where BMI was calculated by weight (in kg) divided by height (in meter2). The respondents were classified as underweight (BMI< 20), normal (BMI = 20 and above but less than 25), overweight (BMI = 25 and above but less than 30) and obese (BMI ≥ 30).
At the first step of analysis, association of level of obesity and prevalence of hypertension [if diastolic blood pressure ≥85 mmHg and systolic blood pressure ≥ 140 mmHg] was investigated. The association of socioeconomic variables and prevalence of obesity hypertension were investigated by Chi-square test, where significant association was decided if the p-value of Chi-square statistic is less than or equal to 0.05. Some adults were more exposed to the disease compared to others. To study this characteristic the odds ratio (O.R.) along with standard error of ln(O.R.) for a particular level of a social variable compared to the level of the variable which did not create problem for the disease was calculated. Discriminant analysis was done to discriminate the adults suffering from obesity hypertension from other group of adults. Important variables were detected by the higher value of correlation coefficient in absolute form of a variable with the discriminant function scores in discriminating adults [28,29]. The analysis was done using the SPSS [Version 25].
Result
The investigated adults were classified into four groups according to their level of body mass index. There were 8.9 percent underweight respondents. Majority (47.5%) of the the respondents were of normal weight. The percentage of overweight respondents was 34.1 and the percentage of obese adults was 9.6 percent. Among the obese adults 26.1 percent were suffering from hypertension. It was observed that among the investigated adults, 15.1 percent were suffering from hypertension and 16.5 percent of them were obese (Table 1).
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