Small area variations and factors associated with blood pressure and body-mass index in adult women in Accra, Ghana: Bayesian spatial analysis of a representative population survey and census data.
Small area variations and factors associated with blood pressure and body-mass index in adult women in Accra, Ghana: Bayesian spatial analysis of a representative population survey and census data.
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DOI：
10.1371/journal.pmed.1003850
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发表时间：
2021-11
期刊：
影响因子：
15.8
通讯作者：
Ezzati M
中科院分区：
文献类型：
--
作者：
Clark SN;Bennett JE;Arku RE;Hill AG;Fink G;Adanu RM;Biritwum RB;Darko R;Bawah A;Duda RB;Ezzati M
撒哈拉以南非洲城市的体重指数（BMI）和血压（BP）水平正在上升，尤其是女性。然而，关于城市内部差异有多大的信息非常有限，这可以为有针对性和公平的卫生政策提供信息。我们的研究旨在分析加纳阿克拉市小区域内成年女性体重指数和血压的空间变化。我们将加纳阿克拉成年女性健康状况的代表性调查（2008 年至 2009 年）与全国人口普查（2010 年）的 10% 随机样本结合起来。我们应用带有空间项的分层模型来估计 BMI、收缩压 (SBP) 和舒张压 (DBP) 与人口、社会经济、行为和环境因素的关联。然后，我们使用该模型估算了阿克拉人口普查中所有女性的 BMI 和 BP，并计算了每个查点区 (EA) 的平均 BMI、SBP 和 DBP。 BMI 和/或血压与年龄、种族 (Ga)、目前已婚和宗教 (穆斯林) 呈正相关，因为它们的 95% 可信区间 (95% CrIs) 不包括零，而血压也与识字率和体力活动呈负相关。 BMI 和 BP 与社会经济地位 (SES) 和饮酒量呈相反的关系。 2010年，18岁及以上女性中有26%患有肥胖症（BMI≥30kg/m2），21%患有未受控制的高血压（SBP≥140和/或DBP≥90mmHg）。第 10 个和第 90 个百分位的 EA 之间的平均 BMI 和血压差异为 2.7 kg/m2 (BMI)，血压差异为 7.9 mm Hg (SBP) 和 4.8 mm Hg (DBP)。阿克拉较富裕的东部地区的 BMI 普遍较高，而该市西部的 BP 较高。我们研究的一个局限性是，用于预测小区域变化的 2010 年人口普查数据集可能已经过时；当下一次人口普查数据可供当代人口使用时，应更新结果，并应评估随时间的变化。我们观察到，阿克拉内不同社区的体重指数和血压差异几乎与全球女性不同国家之间的差异一样大。需要采取本地化措施来解决阿克拉这一不平等的公共卫生挑战。 Sierra N. Clark 及其同事分析了加纳女性血压和体重指数的空间变化以及相关因素。社会、物理和食物环境影响非传染性疾病的空间分布及其危险因素，例如城市社区内部和社区之间的血压 (BP) 和体重指数 (BMI)。在撒哈拉以南非洲 (SSA)，城市发展迅速，BMI 和血压上升，但有关城市内心脏代谢危险因素变化的信息有限。这些信息可以为有针对性和公平的公共卫生计划提供信息。我们结合了一项流行病学研究的数据，该研究对阿克拉的女性进行了随机抽样，以及道路和社区生物质燃料使用的地理空间数据，以了解个人和家庭因素以及居住地如何预测体重指数和血压。在贝叶斯空间模型中对数据进行分析，然后与人口普查数据一起用于预测阿克拉所有女性的血压和体重指数水平。阿克拉境内体重指数和血压的局部差异很大，与世界其他城市和地区的模式类似。根据资产所有权和家庭基础设施衡量，社会经济地位（SES）较高的女性平均体重指数较高。阿克拉各社区的体重指数和血压的空间差异几乎与国家之间的差异一样高。本地化的公共卫生行动可以帮助解决这些差异并减轻由此产生的总体公共卫生负担。
Body-mass index (BMI) and blood pressure (BP) levels are rising in sub-Saharan African cities, particularly among women. However, there is very limited information on how much they vary within cities, which could inform targeted and equitable health policies. Our study aimed to analyse spatial variations in BMI and BP for adult women at the small area level in the city of Accra, Ghana. We combined a representative survey of adult women’s health in Accra, Ghana (2008 to 2009) with a 10% random sample of the national census (2010). We applied a hierarchical model with a spatial term to estimate the associations of BMI and systolic blood pressure (SBP) and diastolic blood pressure (DBP) with demographic, socioeconomic, behavioural, and environmental factors. We then used the model to estimate BMI and BP for all women in the census in Accra and calculated mean BMI, SBP, and DBP for each enumeration area (EA). BMI and/or BP were positively associated with age, ethnicity (Ga), being currently married, and religion (Muslim) as their 95% credible intervals (95% CrIs) did not include zero, while BP was also negatively associated with literacy and physical activity. BMI and BP had opposite associations with socioeconomic status (SES) and alcohol consumption. In 2010, 26% of women aged 18 and older had obesity (BMI ≥ 30 kg/m2), and 21% had uncontrolled hypertension (SBP ≥ 140 and/or DBP ≥ 90 mm Hg). The differences in mean BMI and BP between EAs at the 10th and 90th percentiles were 2.7 kg/m2 (BMI) and in BP 7.9 mm Hg (SBP) and 4.8 mm Hg (DBP). BMI was generally higher in the more affluent eastern parts of Accra, and BP was higher in the western part of the city. A limitation of our study was that the 2010 census dataset used for predicting small area variations is potentially outdated; the results should be updated when the next census data are available, to the contemporary population, and changes over time should be evaluated. We observed that variation of BMI and BP across neighbourhoods within Accra was almost as large as variation across countries among women globally. Localised measures are needed to address this unequal public health challenge in Accra. Sierra N. Clark and colleagues analyze spatial variations of blood pressure and body mass index, and associated factors in Ghanaian women. The social, physical, and food environment influence the spatial distribution of noncommunicable diseases and their risk factors such as blood pressure (BP) and body-mass index (BMI) within and across neighbourhoods in cities. In sub-Saharan Africa (SSA), where cities are growing rapidly and BMI and BP have risen, there is limited information on within-city variation in cardiometabolic risk factors. This information could inform targeted and equitable public health programmes. We combined data from an epidemiological study that had randomly sampled women in Accra and geospatial data on roads and community biomass fuel use to understand how individual and household factors as well as residence predict BMI and BP. Data were analysed in a Bayesian spatial model and then used together with the data from the census to predict BP and BMI levels for all women in Accra. Local area variation in BMI and BP is large within Accra, similar to patterns seen in other cities and regions around the world. Average BMI was higher among women with higher socioeconomic status (SES), as measured by ownership of assets and household infrastructure. The spatial variations in BMI and BP across neighbourhoods in Accra were almost as high as variation seen between countries. Localised public health actions can help address these disparities and reduce the resulting overall public health burden.
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影响因子：
9.3
作者：
Baumgartner, Jill;Brauer, Michael;Ezzati, Majid
通讯作者：
Ezzati, Majid
影响因子：
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作者：
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通讯作者：
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影响因子：
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作者：
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通讯作者：
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影响因子：
3.1
作者：
Adegoke, Babatunde O. A.;Oyeyemi, Adewale L.
通讯作者：
Oyeyemi, Adewale L.
影响因子：
37.8
作者：
Danaei G;Singh GM;Paciorek CJ;Lin JK;Cowan MJ;Finucane MM;Farzadfar F;Stevens GA;Riley LM;Lu Y;Rao M;Ezzati M;Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group
通讯作者：
Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group