Association Between Body Mass index and Prevalence of Multimorbidity in Low-and Middle-income Countries: A Cross-Sectional Study.
Association Between Body Mass index and Prevalence of Multimorbidity in Low-and Middle-income Countries: A Cross-Sectional Study.
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DOI：
10.5530/ijmedph.2016.2.5
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发表时间：
2016-04
期刊：
影响因子：
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通讯作者：
Agrawal PK
中科院分区：
文献类型：
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作者：
Agrawal S;Agrawal PK
慢性病在中低收入国家的发病率和死亡率方面日益成为一种健康负担。在世界上三分之二的肥胖者居住的中低收入国家，体重指数（BMI），特别是超重和肥胖在多发性硬化症（两种或两种以上慢性病的发生）流行中的作用研究不足。我们评估了6个中低收入国家的BMI和慢性非传染性疾病多发病率之间的关系。分析了来自中国（n= 13，970），印度（10，915），墨西哥（2，426），俄罗斯（3，892），南非（4，000）和加纳（4，971）的40，166名参与者的横截面数据，这些参与者年龄在18岁及以上，包括在2007-2010年世界卫生组织全球老龄化和成人健康研究（SAGE）中。多发病是指同时存在心绞痛、关节炎、哮喘、慢性肺病、糖尿病、高血压、中风、抑郁症和视力障碍等9种慢性疾病中的2种或2种以上。在调整年龄、性别、城乡居住地、教育、婚姻状况、职业、家庭财富、吸烟、饮酒、水果和蔬菜摄入以及健康保险状况后，拟合多变量logistic回归模型，以检验超重/肥胖与非传染性多发性骨髓瘤患病率之间的关联。对数据进行了国别分析，并汇总在一起，以得出总体LMIC估计值。汇总国家的平均BMI为24.4 [± 7.3 SD]，印度低至20.8 [±8.0 SD]，加纳为23.4 [±6.3 SD]，中国为23.9 [±4.9 SD]，墨西哥为28.4 [±5.4 SD]，俄罗斯为28.6 [±6.3 SD]，南非高达30.5 [±12.0 SD]。合并样本中超重的患病率为13%，肥胖的患病率为24%。在六个国家的合并样本中，非传染性疾病多发病的患病率为23%，最高的是俄罗斯（50%），其次是墨西哥（27%），印度（24%），加纳（23%），南非（32%）和中国（22%）。在合并样本中，肥胖人群中多发病的患病率为37%，超重人群中为27%-患病率最高的是俄罗斯（肥胖人群为59%;超重人群为45%），最低的是加纳（肥胖人群为28%;超重人群为23%）。肥胖（OR：5.78; 95%CI：3.55-9.40; p<0.0001）与合并样本中与正常体重类别相比具有显著更高的多发性硬化的可能性相关。在俄罗斯，肥胖者发生多项死亡的可能性几乎高出10倍（OR：9.90;95%CI：3.90-25.17;p=<0.0001），在中国高出7倍（OR：7.06;95%CI：2.47-20.21;p=0.003），在加纳高出6倍（OR：5.61;95%CI：1.21-26.02;p= 0.007），在南非高出5倍（OR：4.66;95%CI：2.16-10.08;p=0.005）。在印度和墨西哥的情况下也观察到了不显著但积极的关联。在印度（OR：2.33;95%CI：1.35-4.02;p=0.003）和汇总国家（OR：1.47;95%CI：1.05-2.07;p=0.004）的超重人群中，多发病的可能性高出两倍以上，而在中国、俄罗斯和加纳的病例中也观察到了非显著但正相关的关系。在低收入国家，非传染性疾病多发病率很高，肥胖者比正常体重者高1.5倍。在6个低收入国家中，肥胖与多发性硬化的发生独立相关。这些发现可能对中低收入国家非传染性疾病多发性硬化的公共卫生监测、预防和管理策略至关重要。
Chronic diseases are increasingly becoming a health burden in terms of both morbidity and mortality in low and middle-income countries (LMICs). The role of body mass index (BMI) especially overweight and obesity in the prevalence of multimorbidity, the occurrence of two or more chronic conditions, is understudied in LMICs where two thirds of the world’s obese individuals reside. We estimated the association between BMI and prevalence of chronic non communicable disease multimorbidity in six LMICs. Cross-sectional data of total of 40,166 participants from China (n=13,970), India (10,915), Mexico (2,4 26), Russia (3,892), South Africa (4,000) and Ghana (4,971), aged 18 years and above included in the WHO Study on Global Ageing and adult health (SAGE), 2007–2010 were analyzed. Multimorbidity was measured as the simultaneous presence of two or more of the nine chronic conditions including angina pectoris, arthritis, asthma, chronic lung disease, diabetes mellitus, hypertension, stroke, depression, and vision impairment. Multivariable logistic regression models were fitted to test for associations between overweight/obesity and prevalence of non communicable multimorbidity after adjusting for age, sex, rural/urban residence, education, marital status, occupation, household wealth, tobacco smoking, alcohol drinking, fruits and vegetable intake and health insurance status. Data were analyzed country wise as well as pooled together to give overall LMIC estimates. The mean BMI was 24.4 [±7.3SD] in the pooled countries, being as low as 20.8 [±8.0 SD] in India to 23.4 [±6.3 SD] in Ghana, 23.9 [±4.9 SD] in China, 28.4 [±5.4 SD] in Mexico, 28.6 [±6.3 SD] in Russia, to as high as 30.5 [±12.0 SD] in South Africa. The prevalence of overweight was 13% and obesity was 24% in the pooled sample. The prevalence of non communicable disease multimorbidity was 23% in the pooled sample of six countries–the highest being in Russia (50%), followed by Mexico (27%), India (24%), Ghana (23%), South Africa (32%) and China (22%). The prevalence of multimorbidity was 37% among obese population and 27% among overweight population in the pooled sample–highest prevalence was in Russia (59% among obese; 45% among overweight) and lowest in Ghana (28% among obese; 23% among overweight). Being obese (OR:5.78;95%CI:3.55–9.40;p<0.0001) was associated with significantly higher likelihood of having multimorbidity as compared to normal weight category in the pooled sample. The likelihood of multimorbidity among obese were almost ten times higher in Russia (OR:9.90;95%CI:3.90–25.17;p=<0.0001), seven times higher in China (OR:7.06;95%CI:2.47–20.21;p=0.003), six times higher in Ghana (OR:5.61;95%CI:1.21–26.02;p= 0.007) and five times higher in South Africa (OR:4.66;95%CI:2.16–10.08;p=0.005). Non-significant but positive association were also observed in case of India and Mexico. The likelihood of multimorbidity was more than two times higher among overweight population in India (OR:2.33;95%CI:1.35–4.02;p=0.003) and pooled countries (OR:1.47;95%CI:1.05–2.07;p=0.004) while non-significant but positive association were also observed in case of China, Russia, and Ghana. The prevalence of non communicable disease multimorbidity in the LMICs is high, one and half times higher in obese than in normal weight individual. Obesity was independently associated with the occurrence of multimorbidity in the six LMICs. These findings may be vital for public health surveillance, prevention and management strategies for non communicable disease multimorbidity in the LMICs.