Are the Rates of Hypertension and Diabetes Higher in People from Lower Socioeconomic Status in Bangladesh? Results from a Nationally Representative Survey

May Are the Rates of Hypertension and Diabetes Higher in People from Lower Socioeconomic Status in Bangladesh? Results from a Nationally Representative Survey Md. Ismail Tareque 0 1 2 Atsushi Koshio 0 1 2 Andrew D. Tiedt 0 1 2 Toshihiko Hasegawa 0 1 2 0 1 Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh, 2 The Graduate School of Project Design, Tokyo, Japan, 3 United States Department of Justice , Washington, DC , United States of America, 4 Department of Health Policy and Management, Nippon Medical School , Tokyo , Japan 1 Data Availability Statement: All relevant data are available from the MEASURE DHS Program and the DHS Program Archive (http://www.dhsprogram.com/ data/available-datasets.cfm) 2 Academic Editor: Massimo Ciccozzi, National Institute of Health , ITALY - Funding: Opinions or points of view expressed are those of the authors and do not necessarily reflect the official position or policies of the United States Department of Justice. Andrew D. Tiedt received no financial support for the research, authorship, and/or publication of this article. Md. Ismail Tareque received financial support from the Grant-in-Aid for Young Scientists 24790522 while working as a research A well-established belief regarding inequalities in health around the world is that hypertension and diabetes are higher in groups of lower socioeconomic status. We examined whether rates of hypertension, diabetes, and the coexistence of hypertension and diabetes are higher in people from a lower socioeconomic status than in those from a higher socioeconomic status in Bangladesh. We investigated a nationally representative dataset from the 2011 Bangladesh Demographic and Health Survey with objective measures for hypertension and diabetes. A wealth index was constructed from data on household assets using principal components analysis. Chi-square tests and logistic regressions were performed to test the associations between wealth level, hypertension and diabetes. People from the highest wealth quintile were significantly more likely to have hypertension (Adjusted odds ratios [AOR] = 1.65, 95% confidence interval [CI] = 1.22-2.25), diabetes (AOR = 1.81, 95% CI = 1.21-2.71), and the coexistence of hypertension and diabetes (AOR = 2.17, 95% CI = 1.05-4.49) than people from the lowest wealth quintile. The odds of having hypertension, diabetes, and their coexistence were higher for older people, women, people who engaged in less physical labor, and people who were overweight and obese. analyst and preparing the manuscript in Nippon Medical School. The Grant-in-Aid for Young Scientists 24790522, funded by the Ministry of Education, Culture, Sports, Science, and Technology (MEXT), Japan, was awarded to Atsushi Koshio. MEXT had no further role in the interpretation of data or preparation of this article. Competing Interests: The authors have declared that no competing interests exist. Conclusion Wealthier people, particularly people from the fourth and highest wealth quintiles, should be careful to avoid unhealthy lifestyles to prevent hypertension and diabetes. Health policy makers and planners are urged to target wealthier strata in terms of hypertension and diabetes initiatives while paying special attention to older people, women, people who engage in less physical labor, and individuals who are overweight. Socio-economic disparity is a key public health concern [1]. A well-established belief regarding inequalities in health around the world, particularly in developed regions, is that mortality rates, poorer self-assessment of health, illness, disability, hypertension, diabetes, and non-communicable diseases are higher in groups of lower socioeconomic status [212], whether socioeconomic status is measured in terms of income, education, occupational status, or household assets. A recent study on inequality in disability in Bangladesh reported that people from poor families have a greater likelihood of reporting disabilities than people from wealthier families [13]. To our knowledge, the association between wealth level and health in terms of hypertension and diabetes has never been tested in Bangladesh. High blood pressure acts as one of the contributing and intermediate risk factors for developing coronary heart disease, stroke, and kidney disease. The leading causes of mortality in the world as of 2004 were high blood pressure (13%), tobacco use (9%), high blood glucose (6%), physical inactivity (6%), and being overweight and obese (5%). These factors are responsible for increasing the risk of non-communicable diseases such as heart disease, diabetes and cancers [14]. A recent meta-analysis reported that out of the 1 billion people with hypertension globally, two-thirds reside in low- and middle-income countries. This study reported that higher income, household assets or social class were positively associated with hypertension in rural South Asia whereas no association was detected in rural East Asia [15]. Using data from adults aged 25 to 64 years in Matlab, Bangladesh another study reported that hypertension is more prevalent among females than in males (21% vs 13%, respectively) and increases with age [16]. A meta-analysis of studies between 1995 and 2010 on cardiovascular diseases and diabetes in Bangladesh reported that hypertension was higher among females, elderly, urban people, and working professionals than their counterparts. However, diabetes was higher in males than females, and in urban areas than rural areas, but not statistically significant [17]. On the other hand, a cross-sectional study of 402 adults aged 30 years and older in Dhaka, Bangladesh described a higher proportion of females than males with diabetes [18]. The same study also reported that older age, female sex, being overweight or obese, scoring high on a wealth index and family history of diabetes were positively associated with diabetes or metabolic syndrome. The coexistence of hypertension and diabetes was also discussed as increasing the risk of preeclampsia in pregnant women and end-organ disease among children [19]. In patients with diabetes, hypertension confers an enhanced risk of cardiovascular disease [20]. Therefore, using a nationally representative survey, we examined the critical question of whether people from lower socioeconomic status have higher likelihood of having hypertension, diabetes, and the coexistence of hypertension and diabetes than those from higher socioeconomic status in Bangladesh. Methods Data source This study utilizes data from a nationally representative survey, the 2011 Bangladesh Demographic and Health Survey (BDHS). The 2011 BDHS is the sixth Demographic and Health Survey (DHS) undertaken in Bangladesh. The sampling design, questionnaires, and data collection procedures of the 2011 BDHS are described elsewhere in detail [21]. The 2011 BDHS is the first national survey that included biomarker measurements (...truncated)