References Multiple Regression Analysis For regression analysis the general consideration is that when n sample units are investigated to collect information on several variables, it may happen that some of the variables are interrelated. These factors mentioned here are interrelated and some the factors depend on income. Again, income depends on level of education and profession. Under usual assumptions, the analysis can be done.
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In low-income settings like Nepal, there are few epidemiological studies assessing hypertension burden. Thus, the purpose was to determine prevalence, awareness, treatment, and control of hypertension in Nepal. Increasing age odds ratio [OR]: 1. A number of risk factors were identified as possible drivers of this burden. Thus, there is an urgent need to address modifiable risk factors in semi-urban settings of western Nepal. Study design and tools A cross-sectional survey was conducted across Lekhnath Municipality, a land area of km2 and an estimated total population of 71, The survey tool was adopted from the WHO STEPwise approach to surveillance STEPS , 14 which includes physical measurement height, weight , sociodemographic information age, sex, family size, occupation, income, education, etc.
The questionnaire was validated and previously used by Nepal Health Research Council. The voter database is a comprehensive list of all people with their name, age, sex, and proper address. Each household was assigned a number in a chronological order. Eligible participants from the sampled household were invited to participate. If there were more than one eligible participant in the household at the time of data collection, Kish Method was applied to select a participant.
The Kish method uses a preassigned table of random numbers to find the person to be interviewed. The cuff size was selected based on the upper arm circumference. Physical examination included measurements of height and weight. Weight was measured in light clothes using a digital bathroom scale and recorded in kilograms. Height was measured from the head vertex to the bottom of the feet and read to the nearest centimeter.
Salt intake was measured by asking the participant to provide amount of salt used during the preparation of food and added at the table by each participant in the last 12 hours. The total amount of salt provided by the participant was weighed using a kitchen scale and divided by the total family members who shared food in the last 12 hours. Demographic and anthropometric variables Education was categorized as high secondary or high or trade school, college, or university and low primary education or no education.
Family monthly income was categorized as low and high based on median value. Other demographic variables included were age and sex. The limit for harmful use of alcohol was i men drinking 15 or more standard drinks a week and ii women drinking 8 or more standard drinks a week. One serving of fruit was defined as one medium-size piece of fruit, half a cup of raw, cooked or canned fruit, or half a cup of juice from a fruit not artificially flavored.
Hypertension knowledge, awareness, and treatment Hypertension was defined as a systolic BP of mm Hg or greater; diastolic BP of 90 mm Hg or greater or use of antihypertensive medication.
Chi-square tests were used to explore statistically significant differences between categorical variables. We ran a multiple logistic regression analysis to assess association of hypertension with sex, education, ethnicity, age, BMI, MET, tobacco use, alcohol consumption, salt intake, fruit and vegetable serving, family history of hypertension, diabetes, and total household income per month.
Sampling weight was adjusted to compensate for unequal probabilities of selection in the analyses. Ethical approval The ethics committee of the Nepal Health Research council approved the protocol for the study. Written informed consent was obtained from all study participants. The mean age was Mean systolic and diastolic BP stratified by age group and sex is presented in Figure 1.
The mean systolic and diastolic BP in women was In men, the mean systolic and diastolic BP was The systolic and diastolic BP was higher with each successive age group in both sexes; except for the diastolic BP in the age group that ranged from 55 to 64 years.
Men had higher mean systolic and diastolic BP compared to women Figure 1. The greatest sex difference was observed for mean systolic BP in the age group 25—34 years vs. This difference was lowest in the age group 55—64 years vs. Figure 1. The age-adjusted prevalence was higher in each successive age group irrespectively of sex, education, ethnicity, and income, with exception of the age range 55—64 years old in Janajati men Figure 2.
The sex difference in hypertension prevalence was greatest for the youngest age group; and smallest for the oldest age group. The prevalence of hypertension varied by level of education, ethnicity, and income status. The prevalence was higher among those who had lower education, belonged to Janajati ethnic group, and had low income in almost all age groups and in both sexes Figure 2.
Figure 2. The prevalence of hypertension according to the presence or absence of selected risk factors is shown in Figure 3. Figure 3. Prevalence of hypertension according to the presence or absence of risk factors. The OR of having hypertension among those with 3 to 4 risk factors was 1. Awareness, treatment, and control of hypertension The proportion of awareness, treatment, and control of hypertension is shown in Figure 4.
Figure 4. Awareness, treatment, and control of hypertension in men shaded bars and women solid bars. Association between hypertension and major risk factors The association between hypertension and major cardiovascular disease risk factors among all participants model I , excluding those who knew they had hypertension prior to the survey model II and excluding those who were currently taking antihypertensive medication Model III is presented in Table 1.
Increasing age OR: 1. The association between hypertension and salt consumption was attenuated, whereas the association with the tobacco consumption significantly increased in models II and III. Table 1. Association between hypertension and major risk factors Variables. Model II excluding those who were known their hypertension status prior to the survey. Model III excluding those who were currently under antihypertensive medication.
K C Bhuyan