Background
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identify social risk factors relating to the effective management of elevated serum glucose and hypertension as well as cco-morbid mental health conditions such as depression and anxiety;
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empirically examine the relationship between these social risk factors and health outcomes;
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and explore the social and behavioral risk factors for the poor management of NCDs.
Methods
Study design
Setting
Sample size
Sampling
Measures
Statistical analysis
Results
Characteristics of study population
Not hypertensive | Hypertensive | χ² ,p value | Not diabetic | Diabetic | χ2, p value | Male | Female | χ2, p value | Total | |
---|---|---|---|---|---|---|---|---|---|---|
Age | ||||||||||
30–39 | 185 (22.8%) | 18 (9.7%) | χ2 = 22.40, p < 0.001 | 188 (22.51%) | 15 (9.3%) | χ2 = 35.33, p < 0.001 | 61 (16.7%) | 142 (22.5%) | χ2 = 10.78, p = 0.029 | 203 (20.4%) |
40–49 | 163 (20.1%) | 39 (21.1%) | 182 (21.80%) | 20 (12.4%) | 66 (18.1%) | 136 (21.5%) | 202 (20.3%) | |||
50–59 | 173 (21.3%) | 50 (27.0%) | 171 (20.48%) | 52 (32.1%) | 81 (22.2%) | 142 (22.5%) | 223 (22.4%) | |||
60–69 | 171 (21.1%) | 57 (30.8%) | 174 (20.84%) | 54 (33.3%) | 96 (26.3%) | 132 (20.9%) | 228 (22.9%) | |||
70+ | 120 (14.8%) | 21 (11.4%) | 120 (14.37%) | 21 (13.0%) | 61 (16.7%) | 80 (12.7%) | 141 (14.1%) | |||
Gender | ||||||||||
Male | 276 (34.0%) | 89 (48.1%) | χ2 = 12.94, p < 0.001 | 298 (35.7%) | 67 (41.4%) | ns | – | – | – | 365 (36.6%) |
Female | 536 (66.0%) | 96 (51.9%) | 537 (64.3%) | 95 (58.6%) | – | – | 632 (63.4%) | |||
Education | ||||||||||
None | 32 (3.9%) | 9 (4.9%) | χ2 = 15.13, p = 0.004 | 32 (3.8%) | 9 (5.6%) | χ2 = 20.80, p < 0.001 | 6 (1.6%) | 35 (5.5%) | χ2 = 12.12, p = 0.016 | 41 (4.1%) |
Did not complete primary | 178 (21.9%) | 49 (26.5%) | 186 (22.3%) | 41 (25.3%) | 79 (21.6%) | 148 (23.4%) | 227 (22.8%) | |||
Completed primary | 243 (29.9%) | 68 (36.8%) | 246 (29.5%) | 65 (40.1%) | 126 (34.5%) | 185 (29.3%) | 311 (31.2%) | |||
Completed secondary | 176 (21.7%) | 40 (21.6%) | 182 (21.8%) | 34 (21.0%) | 85 (23.3%) | 131 (20.7%) | 216 (21.7%) | |||
Completed tertiary | 183 (22.5%) | 19 (10.3%) | 189 (22.6%) | 13 (8.0%) | 69 (18.9%) | 133 (21.0%) | 202 (20.3%) | |||
Literacy | ||||||||||
Able to read newspaper | 748 (92.1%) | 174 (94.1%) | ns | 774 (92.7%) | 148 (91.4%) | ns | 348 (95.3%) | 574 (90.8%) | χ2 = 6.79, p = 0.009 | 922 (92.5%) |
Occupation | ||||||||||
Paid work | 266 (32.8%) | 75 (40.5%) | ns | 284 (34.0%) | 57 (35.2%) | ns | 224 (61.4%) | 117 (18.5%) | χ2 = 305.2, p < 0.001 | 341 (34.2%) |
Unemployed | 206 (25.4%) | 33 (17.8%) | 195 (23.4%) | 44 (27.2%) | 69 (18.9%) | 170 (26.9%) | 239 (24.0%) | |||
Housewife / husband | 275 (33.9%) | 62 (33.5%) | 291 (34.9%) | 46 (28.4%) | 18 (4.9%) | 319 (50.5%) | 337 (33.8%) | |||
Retired | 65 (8.0%) | 15 (8.1%) | 65 (7.8%) | 15 (9.3%) | 54 (14.8%) | 26 (4.1%) | 80 (8.0%) | |||
Marital status | ||||||||||
Never married | 12 (1.5%) | 6 (3.2%) | ns | 16 (1.9%) | 2 (1.2%) | ns | 11 (3.0%) | 7 (1.1%) | χ2 = 63.14, p < 0.001 | 18 (1.8%) |
Married | 675 (83.1%) | 149 (80.5%) | 696 (83.4%) | 128 (79.0%) | 340 (93.2%) | 484 (76.6%) | 824 (82.7%) | |||
Widowed / divorced / separated | 125 (15.4%) | 30 (16.2%) | 123 (14.7%) | 32 (19.8%) | 14 (3.8%) | 141 (22.3%) | 155 (15.6%) | |||
Social network typology | ||||||||||
Family dependent | 80 (9.9%) | 18 (9.7%) | ns | 86 (10.3%) | 12 (7.4%) | ns | 36 (9.9%) | 62 (9.8%) | χ2 = 20.75, p < 0.001 | 98 (9.8%) |
Locally integrated | 215 (26.5%) | 52 (28.1%) | 220 (26.4%) | 47 (29.0%) | 125 (34.3%) | 142 (22.5%) | 267 (26.8%) | |||
locally self-contained | 79 (9.7%) | 18 (9.7%) | 76 (9.1%) | 21 (13.0%) | 28 (7.7%) | 69 (10.9%) | 97 (9.7%) | |||
Wider community focus | 208 (25.6%) | 48 (26.0%) | 210 (25.2%) | 46 (28.4%) | 94 (25.8%) | 162 (25.6%) | 256 (25.7%) | |||
Private | 230 (28.3%) | 49 (26.5%) | 243 (29.1%) | 36 (22.2%) | 82 (22.5%) | 197 (31.2%) | 279 (28.0%) | |||
Depression | ||||||||||
non-case | 683 (84.1%) | 158 (85.4%) | ns | 705 (84.4%) | 136 (84.0%) | ns | 334 (91.5%) | 507 (80.2%) | χ2 = 22.33, p < 0.001 | 841 (84.4%) |
probable case | 129 (15.9%) | 27 (15.0%) | 130 (15.6%) | 26 (16.1%) | 31 (8.5%) | 125 (19.8%) | 156 (15.7%) | |||
Anxiety | ||||||||||
non-case | 636 (78.3%) | 147 (79.5%) | ns | 653 (78.2%) | 130 (80.3%) | ns | 321 (88.0%) | 462 (73.1%) | χ2 = 30.24, p < 0.001 | 783 (78.5%) |
probable case | 176 (21.7%) | 38 (20.5%) | 182 (21.8%) | 32 (19.8%) | 44 (12.1%) | 170 (26.9%) | 214 (21.5%) | |||
Risk factor- smoking | ||||||||||
Yes | 102 (12.6%) | 46 (24.9%) | χ2 = 18.04, p < 0.001 | 721 (86.4%) | 128 (79.0%) | χ2 = 5.77, p = 0.016 | 132 (36.2%) | 16 (2.5%) | χ2 = 207.04, p < 0.001 | 148 (14.8%) |
No | 710 (87.4%) | 139 (75.1%) | 114 (13.7%) | 34 (21.0%) | 233 (63.8%) | 616 (97.5%) | 849 (85.2%) | |||
Risk factor- Alcoholism | ||||||||||
Yes | 91 (11.2%) | 39 (21.1%) | χ2 = 12.95, p < 0.001 | 105 (12.6%) | 25 (15.4%) | ns | 115 (31.5%) | 15 (2.4%) | χ2 = 173.19, p < 0.001 | 130 (13.0%) |
No | 721 (88.8%) | 146 (78.9%) | 730 (87.4%) | 137 (84.6%) | 250 (68.5%) | 617 (97.6%) | 867 (86.9%) | |||
Told High Blood Pressure | ||||||||||
No | 568 (70.0%) | 96 (51.9%) | χ2 = 22.08, p < 0.001 | 573 (68.6%) | 91 (56.2%) | χ2 = 9.45, p = 0.002 | 270 (74.0%) | 394 (62.3%) | χ2 = 14.07, p < 0.001 | 664 (66.6%) |
Yes | 244 (30.1%) | 89 (48.1%) | 262 (31.4%) | 71 (43.8%) | 95 (26.0%) | 238 (37.7%) | 333 (33.4%) | |||
Told Diabetes | ||||||||||
No | 616 (75.9%) | 122 (66.0%) | χ2 = 7.70, p = 0.006 | 696 (83.4%) | 42 (25.9%) | χ2 = 232.69, p < 0.001 | 272 (74.5%) | 466 (73.7%) | χ2 = 14.07, p < 0.001 | 738 (74.0%) |
Yes | 196 (24.1%) | 63 (34.1%) | 139 (16.7%) | 120 (74.1%) | 93 (25.5%) | 166 (26.3%) | 259 (26.0%) | |||
WHODAS | ||||||||||
Quartile 1 | 262 (32.3%) | 57 (30.8%) | ns | 278 (33.3%) | 41 (25.3%) | ns | 159 (43.6%) | 160 (25.3%) | χ2 = 45.04, p < 0.001 | 319 (32.0%) |
Quartile 2 | 153 (18.8%) | 34 (18.4%) | 160 (19.2%) | 27 (16.7%) | 70 (19.2%) | 117 (18.5%) | 187 (18.8%) | |||
Quartile 3 | 206 (25.4%) | 51 (27.6%) | 211 (25.3%) | 46 (28.4%) | 82 (22.5%) | 175 (27.7%) | 257 (25.8%) | |||
Quartile 4 | 191 (23.5%) | 43 (23.2%) | 186 (22.3%) | 48 (29.6%) | 54 (14.8%) | 180 (28.5%) | 234 (23.5%) |
Prevalence of social and lifestyle risk factors among participants with high blood pressure or blood glucose
Effect of social, behavioural and mental health conditions on blood pressure and blood glucose
CLASS 1 Behavioural risk group | CLASS 2 Social risk group | CLASS 3 Low risk group | χ2, p value | |
---|---|---|---|---|
Age | ||||
30–39 | 34 (19.5%) | 9 (6.5%) | 160 (23.4%) | χ2 = 86.91, p < 0.001 |
40–49 | 28 (16.1%) | 18 (13.0%) | 156 (22.8%) | |
50–59 | 43 (24.7%) | 22 (15.8%) | 158 (23.1%) | |
60–69 | 47 (27.0%) | 40 (28.8%) | 141 (20.6%) | |
70+ | 22 (12.6%) | 50 (36.0%) | 69 (10.1%) | |
Gender | ||||
Male | 157 (90.2%) | 31 (22.3%) | 177 (25.9%) | χ2 = 261.78, p < 0.001 |
Female | 17 (9.8%) | 108 (77.7%) | 507 (74.1%) | |
Marital status | ||||
Married | 162 (93.1%) | 79 (56.8%) | 583 (85.2%) | χ2 = 81.04, p < 0.001 |
Unmarried / widowed / separated | 12 (6.9%) | 60 (43.2%) | 101 (14.8%) | |
Income | ||||
Above median | 109 (62.6%) | 67 (48.2%) | 404 (59.1%) | χ2 = 7.33, p = 0.026 |
Below median | 65 (37.4%) | 72 (51.8%) | 280 (40.9%) | |
Wenger social network | ||||
Integrated social network | 4 (2.3%) | 5 (3.6%) | 27 (4.0%) | ns |
Non-integrated social network | 170 (97.7%) | 134 (96.4%) | 657 (96.1%) | |
Occupation | ||||
Unemployed | 25 (14.4%) | 54 (38.9%) | 160 (23.4%) | χ2 = 163.59, p < 0.001 |
Employed | 118 (67.8%) | 22 (15.8%) | 201 (29.4%) | |
Housewife / husband | 6 (3.5%) | 54 (38.9%) | 277 (40.5%) | |
Retired | 25 (14.4%) | 9 (6.5%) | 46 (6.7%) | |
Education | ||||
Completed primary | 36 (20.7%) | 88 (63.3%) | 144 (21.1%) | χ2 = 119.89, p < 0.001 |
Completed secondary | 111 (63.8%) | 44 (31.7%) | 372 (54.4%) | |
Completed tertiary | 27 (15.5%) | 7 (5.0%) | 168 (24.6%) | |
Disability | ||||
1st quartile | 83 (47.7%) | 1 (0.7%) | 235 (34.4%) | χ2 = 334.26, p < 0.001 |
2nd quartile | 36 (20.7%) | 4 (2.9%) | 147 (21.5%) | |
3rd quartile | 38 (21.8%) | 19 (13.7%) | 200 (29.2%) | |
4th quartile | 17 (9.8%) | 115 (82.7%) | 102 (14.9%) | |
Hypertension (diagnosed) | ||||
No | 119 (68.4%) | 117 (84.2%) | 576 (84.2%) | χ2 = 23.77, p < 0.001 |
Yes | 55 (31.6%) | 22 (15.8%) | 108 (15.8%) | |
Diabetes (diagnosed) | ||||
No | 140 (80.4%) | 112 (80.5%) | 586 (85.7%) | ns |
Yes | 34 (19.5%) | 27 (19.4%) | 98 (14.3%) |
Diagnosed Diabetic | Diagnosed Hypertensive | |
---|---|---|
Relative risk ratio (95% CI), p value | Relative risk ratio (95% CI), p value | |
Class Groups | ||
Low risk group (comparator) | 1 | 1 |
Behavioural risk group | 1.45 (0.94–2.24), p = 0.090 | 2.46 (1.69–3.60), p < 0.001 |
Social risk group | 1.44 (0.90–2.31), p = 0.128 | 1.00 (0.61–1.65), p = 0.991 |