The Burden and Determinants of Non Communicable Diseases Risk Factors in Nepal: Findings from a Nationwide STEPS Survey.
The Burden and Determinants of Non Communicable Diseases Risk Factors in Nepal: Findings from a Nationwide STEPS Survey.
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DOI：
10.1371/journal.pone.0134834
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Karki KB
中科院分区：
文献类型：
--
作者：
Aryal KK;Mehata S;Neupane S;Vaidya A;Dhimal M;Dhakal P;Rana S;Bhusal CL;Lohani GR;Paulin FH;Garg RM;Guthold R;Cowan M;Riley LM;Karki KB
世界卫生组织(WHO)估计，尼泊尔非传染性疾病(NCDs)导致的死亡人数从2010年的51%上升到2014年的60%。这项研究评估了非传染性疾病危险因素在尼泊尔成年人群中的分布和决定因素。2013年1月至6月，使用世卫组织非传染性疾病STEPS工具，对非传染性疾病危险因素的流行率进行了具有全国代表性的横断面调查。采用多阶段整群抽样的方法，随机抽取4200名受访者。调整后的患病率(APR)用泊松回归模型评估非传染性疾病危险因素的决定因素。目前吸烟(最近30天)的患病率为19%(95%可信区间：16.6-20.6)，有害饮酒(男性平均每天摄入60克纯酒精，女性平均每天摄入40克纯酒精)为2%(95%可信区间：1.4-2.9)。几乎所有的受访者(99%，95%CI：98.3-99.3)平均每天摄入的水果和蔬菜少于5份，3%(95%CI：2.7-4.3)的人体力活动较少。约21%(95%可信区间：19.3-23.7)为超重或肥胖(体重指数≥为25)。血压升高(SBP≥为14 0 mm Hg或DBP≥为90 mm Hg)和血糖升高(空腹血糖≥12 6 mg/dl)的发生率分别为2 6%(95%CI：2 3.6~2 8.0)和4%(95%CI：2.9~4.5)。几乎四分之一的受访者，即23%(95%可信区间：20.5-24.9)，总胆固醇升高(总胆固醇≥为190毫克/分升或在目前治疗胆固醇升高的药物范围内)。这项研究显示，女性的吸烟率低于男性(APR：0.30；95%CI：0.25-0.36)，受教育程度较高的人比没有受过正规教育的人(APR：0.39；95%CI：0.26-0.58)更低。女性的有害酒精使用也低于男性(APR：0.26；95%CI：0.14-0.48)，Terai居民的有害酒精使用低于山区居民(APR：0.16；95%CI：0.07-0.36)。女性缺乏体力活动的比例低于男性(APR：0.55；95%CI：0.38-0.80)，但女性的超重和肥胖程度明显更高(APR：1.19；95%CI：1.02-1.39)。山区居民超重或肥胖的发生率显著低于山区居民(APR：0.41；95%CI：0.21-0.80)，农村居民明显低于城市居民(APR：1.39；95%CI：1.15-1.67)。女性血压升高的发生率低于男性(APR：0.69；95%CI：0.60-0.80)。城市居民的血糖升高患病率高于农村居民(APR：2.05；95%CI：1.29-3.25)。在受教育程度较高的受访者中，观察到总胆固醇升高的患病率高于未受过正规教育的受访者(APR：1.76；95%CI：1.35-2.28)。在尼泊尔人口中，水果和蔬菜消费量低、超重和肥胖、血压升高和总胆固醇升高的比例明显较高，并因人口和生态因素以及城市化而有所不同。在尼泊尔，预防、治疗和控制非传染性疾病及其风险因素是该国一个新出现的公共卫生问题，迫切需要采取多部门办法采取有针对性的干预措施。
World Health Organization (WHO) estimates for deaths attributed to Non Communicable Diseases (NCDs) in Nepal have risen from 51% in 2010 to 60% in 2014. This study assessed the distribution and determinants of NCD risk factors among the Nepalese adult population. A nationally representative cross-sectional survey was conducted from Jan to June 2013 on the prevalence of NCD risk factors using the WHO NCD STEPS instrument. A multistage cluster sampling method was used to randomly select the 4,200 respondents. The adjusted prevalence ratio (APR) was used to assess the determinants of NCD risk factors using a Poisson regression model. The prevalence of current smoking (last 30 days) was 19% (95%CI:16.6-20.6), and harmful alcohol consumption (≥60 g of pure alcohol for men and ≥40 g of pure alcohol for women on an average day) was 2% (95%CI:1.4-2.9). Almost all (99%, 95%CI:98.3-99.3) of the respondents consumed less than five servings of fruits and vegetables combined on an average day and 3% (95%CI:2.7-4.3) had low physical activity. Around 21% (95%CI:19.3-23.7) were overweight or obese (BMI≥25). The prevalence of raised blood pressure (SBP≥140 mm of Hg or DBP≥90 mm of Hg) and raised blood glucose (fasting blood glucose ≥126 mg/dl), including those on medication were 26% (95%CI:23.6-28.0) and 4% (95%CI:2.9-4.5) respectively. Almost one quarter of respondents, 23% (95%CI:20.5-24.9), had raised total cholesterol (total cholesterol ≥190 mg/dl or under current medication for raised cholesterol). he study revealed a lower prevalence of smoking among women than men (APR:0.30; 95%CI:0.25-0.36), and in those who had higher education levels compared to those with no formal education (APR:0.39; 95%CI:0.26-0.58). Harmful alcohol use was also lower in women than men (APR:0.26; 95%CI:0.14-0.48), and in Terai residents compared to hill residents (APR:0.16; 95%CI:0.07-0.36). Physical inactivity was lower among women than men (APR:0.55; 95%CI:0.38-0.80), however women were significantly more overweight and obese (APR:1.19; 95%CI:1.02-1.39). Being overweight or obese was significantly less prevalent in mountain residents than in hill residents (APR:0.41; 95%CI:0.21-0.80), and in rural compared to urban residents (APR:1.39; 95%CI:1.15-1.67). Lower prevalence of raised blood pressure was observed among women than men (APR:0.69; 95%CI: 0.60-0.80). Higher prevalence of raised blood glucose was observed among urban residents compared to rural residents (APR:2.05; 95%CI:1.29-3.25). A higher prevalence of raised total cholesterol was observed among the respondents having higher education levels compared to those respondents having no formal education (APR:1.76; 95%CI:1.35-2.28). The prevalence of low fruit and vegetable consumption, overweight and obesity, raised blood pressure and raised total cholesterol is markedly high among the Nepalese population, with variation by demographic and ecological factors and urbanization. Prevention, treatment and control of NCDs and their risk factors in Nepal is an emerging public health problem in the country, and targeted interventions with a multi-sectoral approach need to be urgently implemented.