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Social and lifestyle factors associated with hypertension in Bahraini community Abdulrahman O. Musaiger
Hypertension in Bahraini community 213
Department of Nutrition and Health Studies, University of Bahrain, Manama, Bahrain
Mariam Al-Mannai Department of Statistics, University of Bahrain, Manama, Bahrain, and
Khaldoon Al-Roomi Department of Community Medicine, Arabian Gulf University, Manama, Bahrain Abstract Purpose – Hypertension is one of important risk factors for cardiovascular disease, which represents 30 per cent of annual total deaths in Bahrain. Studies on factors associated with hypertension in Bahrain are very limited. The present paper aimed to highlight some social and lifestyle factors that may be associated with hypertension in Bahraini community. Design/methodology/approach – A cross-sectional household survey was carried out using a multistage sampling technique to select 514 Bahraini adults aged 30-79 years. A pretested validated questionnaire was used. History of hypertension and diabetes was determined by positive response to previous diagnosis of these diseases. Findings – The risk of occurrence of hypertension was greater in older people, women, illiterate people, non-smokers, those who did not walk regularly, those who watched television daily, obese people, those who had a history of diabetes and those who consumed vegetables more than four times a week. However, age, gender, education, obesity and diabetes were the main risk factors statistically associated with hypertension using bivariate analysis ( p , 0.01). When multiple logistic regression was used, only age ( p , 0.01) and obesity ( p , 0.05) were found to be statistically significant. Originality/value – Social, lifestyle and dietary factors should be considered in any intervention programme to prevent and control hypertension in Bahraini community. Keywords Hypertension, Lifestyles, Dietary habits, Social factors, Bahrain Paper type Research paper
Introduction Hypertension is a major public health problem in the Arab Gulf countries, including Bahrain (Al-Said, 2005). In addition, high blood pressure is a well-established risk factor for coronary heart disease (CHD) and cerebrovascular disease (CVD), which are currently among the leading causes of death in these countries (Musaiger and Al-Hazzaa, 2012). In Bahrain, it was reported that 30 per cent of total annual deaths were due to CHD (Ministry of Health, 2009). Data on the impact of many lifestyle factors on the prevalence of hypertension in Bahrain is lacking, and most of studies focused on risk factors of CHD and diabetes. However, indicator showed that hypertension is a serious health problem among adults in the Arab Gulf Region (Sabri et al., 2004; Bener et al., 2004b; Al-Hamdan et al., 2011). The present paper
Nutrition & Food Science Vol. 43 No. 3, 2013 pp. 213-217 q Emerald Group Publishing Limited 0034-6659 DOI 10.1108/00346651311327855
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examined some of the social and lifestyle risk factors that may be associated with the occurrence of hypertension in the adult Bahraini population. Method Data of this study were obtained through a community-based household survey on risk factors for some chronic diseases among Bahraini nationals aged 30-79 years. A multistage clustering sample technique was used to select the subjects from households. Bahrain was divided administratively into 11 geographical areas, a total of 337 blocks. A random sample of 52 blocks (15 per cent) was selected using random tables. A probability random sample was obtained from lists of households in each of the selected blocks, and ten households were chosen from each block, yielding a total sample of 520 households. The total sample included was 514 due to incompleteness of six questionnaires. One person aged 30-79 years was selected from each household, by selecting the first subject aged 30 years or above available in the households at the time of interview. People were interviewed at home by trained female interviewers using a structured pre-tested questionnaire which included information on socio-demographic characteristics, lifestyle patterns and weight and height (Musaiger and Al-Manni, 2002). History of hypertension and diabetes was assessed by positive response to the question about whether or not a doctor had ever told the subject that he or she had hypertension and/or diabetes. Smoking was classified into two categories, non-smokers which included those who had never smoked regularly as well as persons who had given up smoking for at least six months, while smokers were defined as those who smoked at least one cigarette per day regularly. Weight was measured to the nearest 0.2 kg using a Seca digital scale. The weight was taken without shoes and with as few clothes as possible. Height was measured to the nearest 0.1 cm using a Seca portable stadiometer. Body mass index (BMI) (weight (kg)/height (m)2) was used to determine obesity among the study population. The subjects were classified into two levels, non-obese, which included those who has a BMI less than 25, and obese, which included those who had a BMI equal to or more than 25 overweight and obese, as described by WHO (1998). Overweight (BMI 25-29.9) and obese (BMI $ 30) were grouped into one category because we found there was no significant differences in social and lifestyle factors between overweight and obese subjects. Data were analyzed using SPSS software package, version 12. Crude odds ratio was computed to estimate the risk of hypertension in various social and lifestyle categories. Adjusted odds ratios with their 95 per cent approximate confidence intervals, were determined using logistic regression analysis. Results and discussion The overall prevalence of hypertension among adult Bahrainis (30-79 years) was 12.3 per cent. Social and lifestyle factors associated with occurrences of hypertension in adult Bahraini natives are presented in Table I. The risk of occurrence of hypertension (based on crude odds ratios, OR) was higher in older people, female, illiterate, unmarried, non-smokers, those who watched television daily, obese, those who have a history of diabetes, and those who consumed fresh vegetable more than three times a week. However, age, gender, education, obesity and diabetes were only found to be statistically associated with hypertension ( p , 0.01).
Factor
Hypertensive No %
Age (years) 30-49 17 27.0 50-79 46 73.0 Gender Male 27 42.9 Female 36 57.1 Education Illiterate 47 74.6 Educated 16 25.4 Marital status Currently married 57 90.5 Currently unmarried 6 9.5 Smoking Smoker 13 20.6 Non-smoker 50 79.4 Walking regularly No 21 33.3 Yes 42 66.7 Watching TV Rarely or occasionally 10 15.1 Daily 53 84.1 Obesity Non-obese 11 17.5 Obese 52 82.5 History of diabetes No 48 76.2 Yes 15 23.8 Frequency of fruit intake per week 1-3 18 28.6 4þ 45 71.4 Frequency of vegetable intake per week 1-3 6 9.5 4þ 57 90.5
Normotensive No %
Crude Odds ratio
Adjusted Odds ratio
95% CI
1.37-5.72
229 222
50.8 49.2
1.00 * 2.79
1.00 * 2.80
271 180
59.9 40.1
1.00 * 2.01
1.00 1.58
0.76-3.00
244 207
54.1 45.9
1.00 * 0.40
1.00 0.66
0.32-1.39
419 32
92.9 7.1
1.00 1.38
1.00 1.05
0.38-2.90
128 323
28.4 71.6
1.00 1.52
1.00 1.43
0.71-2.86
152 299
33.7 66.3
1.00 1.02
1.00 0.71
0.38-1.33
99 352
22.0 78.0
1.00 1.49
1.00 1.67
0.78-3.58
163 288
36.1 63.9
1.00 * 2.68
1.00 * * 2.49
1.19-5.21
420 31
93.1 6.9
1.00 * 4.23
1.00 3.14
0.39-6.64
137 314
30.4 69.6
1.00 1.09
1.00 0.86
0.45-1.66
82 369
18.2 81.8
1.00 2.11
1.00 1.86
0.73-4.73
Hypertension in Bahraini community 215
Note: Significant at: *p , 0.01 and * *p , 0.05
When multiple logistic regression was used to estimate the risk of occurrence of hypertension in relation to social and lifestyle factors, almost the same trend was observed, but the factors that statistically contributed to occurrence of hypertension were only age and obesity. The adjusted odds ratios (adjusted for all confounding variables) for occurrence of hypertension in older subjects (aged 50-79 years) was 2.80 times (95 per cent CI, 1.37-5.72) higher than those age 30-49 years and in obese subjects was 2.49 times (95 per cent CI, 1.19-5.21), higher than non-obese. Even after adjustment with all other confounding factors such as age, gender and lifestyle patterns, smoking was not associated with hypertension. This finding was also reported by Bener et al. (2004a) in Qatar and by Jaddou et al. (1996) in Jordan, which may be due to lack of information on the duration of smoking, number of cigarettes smoked daily, and ex-smokers, in the present study. Diabetes mellitus was
Table I. Bivariate analysis (crude odds ratios) and logistic regression-derived odds ratios and 95 per cent confidence intervals (CI) for social and lifestyle risk factors for hypertension among 514 Bahraini natives
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associated with an increased prevalence of hypertension. This is consistent with findings of other studies in the region (Al Riyami and Afifi, 2002; Bener et al., 2004a, b; Elkhalifa et al., 2011), and may suggest that common etiological factors apply for both diabetes and hypertension. Obesity was also main factors for hypertension. The prevalence of obesity among both children and adults in Bahrain is increasing dramatically during the past three decades (Bader et al., 2008). This may lead to raise the risk for hypertension among Bahraini community at an early age. Therefore, combating obesity should be included in any program to prevent and control chronic non-communicable diseases, including hypertension. Some limitations should be considered when interpreting the finding of this study. First, although the multivariate analysis adjust for the effect of other factors, several confounding factors may have interfered with the findings, such as economic background, ethnic origin and prevalence of other chronic diseases. Second, data depends on known hypertension, and therefore some cases may not have been included. Nevertheless, the findings of the present study indicate, as in developed countries, that some lifestyle and social factors may have a significant association with the occurrence of hypertension. Health programmes to prevent and control non-communicable diseases such as hypertension in Bahrain, should take into consideration the various socio-economic, dietary and lifestyle factors that increase the risk of occurrence of these diseases. Further in-depth and cohort studies are urgently needed to explore the magnitude of each risk factor for hypertension as well as for cardiovascular disease and diabetes. It is hoped that this preliminary study would provide baseline data for more comprehensive study. References Al-Hamdan, N., Saeed, A., Kutabi, A., Choudhry, A.J. and Nooh, R. (2011), “Characteristics, risk factors, and treatment practices of known adult hypertensive patients in Saudi Arabia”, International Journal of Hypertension, (2010, article no. 168739). Al Riyami, A.A. and Afifi, M.M. (2002), “Hypertension in Oman: distribution and correlates”, The Journal of the Egyptian Public Health Association, Vol. 77 Nos 3/4, pp. 383-407. Al-Said, J. (2005), “The prevalence of hypertension in Persian Gulf countries and its correlation with demographic and socio-economic factors”, Journal of Hypertensions, Vol. 23 No. 6, pp. 1275-12777. Bader, Z., Musaiger, A.O., AL-Roomi, K. and D’Souza, R. (2008), “Overweight and obesity among adolescents in Bahrain”, Anthropologischer Anzieger, Vol. 66 No. 4, pp. 401-407. Bener, A., Al-Suwaidi, J., Al-Jaber, K., Al-Marri, S. and Elbagi, I.E. (2004a), “Epidemiology of hypertension and its associated risk in the Qatari population”, Journal of Human Hypertensions, Vol. 18 No. 7, pp. 529-530. Bener, A., Al-Suwaidi, J., Al-Jaber, K., Al-Marri, S., Dagash, M. and Elbagi, I.A. (2004b), “The prevalence of hypertension and its associated risk factors in a newly developed country”, Saudi Medical Journal, Vol. 25 No. 7, pp. 918-922. Elkhalifa, A.M., Kinsara, A.J. and Almadani, D.A. (2011), “Prevalence of hypertension in a population of healthy individuals”, Med Principles and Practice, Vol. 20 No. 2, pp. 152-155. Jaddou, H.Y., Batiehah, A.M. and Ajlouni, K.M. (1996), “Prevalence and associated factors of hypertension: results from a three community-based survey, Jordan”, Journal of Human Hypertensions, Vol. 10 No. 12, pp. 815-821.
Ministry of Health. Health Statics (2009), Health Information Section, Ministry of Health, Bahrain, 2010. Musaiger, A.O. and Al-Hazzaa, H.M. (2012), “Prevalence and risk factors associated with nutrition-related non-communicable diseases in the Eastern Mediterranean region”, International Journal of General Medicine, Vol. 5, pp. 119-217. Musaiger, A.O. and Al-Manni, M.A. (2002), “Social and lifestyle factors associated with diabetes”, Journal of Biosocial Science, Vol. 34 No. 2, pp. 277-281. Sabri, S., Benen, A. and Eapen, V. (2004), “Some risk factors for hypertension in the United Arab Emirates”, Eastern Mediterranean Health Journal, Vol. 10 Nos 4/5, pp. 610-619. WHO (1998), “Obesity and managing the global epidemic”, WHO Technical Report No. 894, World Health Organization, Geneva. Corresponding author Abdulrahman O. Musaiger can be contacted at:
[email protected]
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