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presented by Trevor Ferguson on behalf of JHLS-III Investigators

Jamaica Health and Lifestyle Survey 2016 - 2017: Prevalence of NCD Risk Factors and Cardiovascular Disease. presented by Trevor Ferguson on behalf of JHLS-III Investigators. Introduction – NCDs and Public Health.

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presented by Trevor Ferguson on behalf of JHLS-III Investigators

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  1. Jamaica Health and Lifestyle Survey 2016 - 2017: Prevalence of NCD Risk Factors and Cardiovascular Disease presented by Trevor Ferguson on behalf of JHLS-III Investigators

  2. Introduction – NCDs and Public Health • Noncommunicable diseases (NCDs), including heart disease, stroke, cancer, diabetes, and chronic lung disease remain a global public health problem • NCDs are responsible for 71% of deaths globally • In Jamaica, NCDs accounted for approximately 62% of deaths among men and 74% of deaths among women in 2016

  3. Introduction – NCDs and Public Health • Data from JHLS-II, completed in 2007-2008, showed high prevalence of behavioural and metabolic risk factors for NCDs • JHLS-III, conducted between 2016-2017, provides updated estimates on the burden of NCDs and their risk factors

  4. Content Covered • Obesity • Diabetes mellitus • Hypertension • High Cholesterol • Heart Attack • Stroke

  5. Study Design • A community based interviewer-administered health examination survey of non-institutionalised Jamaicans, resident in Jamaica, aged 15 years and older • Designed to be nationally representative • Multi-stage sampling design • Randomly selected rural and urban enumeration districts stratified by parish • Systematic sampling of households within each ED • One participant selected per household – using Kish method

  6. Weighted Analyses • Sampling weights – based on • Probability of selection of dwellings and enumeration districts • Adjusted for unit non-response • Calibrated using population distribution at parish-level sex-specific by 5-year age bands

  7. Weighted Estimates • More conservative estimates of the variability associated with the statistics • Description that can be generalised to Jamaican population of 15 years and older

  8. Recruitment

  9. The Recruited Sample • 1089 (38.8%) males, 1718 (61.2%) females

  10. RESULTS

  11. Distribution of Nutritional Status by Sex (BMI categories) 54% of persons ≥15 yrs were overweight (25% pre-obese; 29% obese) Pre-obese = BMI 25.0-29.9; Obese = BMI≥30 kg/m2 p<0.001 for male: female difference

  12. Pre-Obesity and Obesity by Age • High prevalence of overweight (pre-obesity and obesity) in all age groups • Lowest in 15-24 age group • Highest among those 35-44 & 45-54 years • Small decrease in the older age groups Pre-obese = BMI 25.0-29.9; Obese = BMI≥30 kg/m2

  13. Prevalence of obesity by sex(BMI ≥30 kg/m2) Marked sex difference in prevalence of obesity – female >> male

  14. Prevalence of Obesity (BMI ≥30) by Parish (Females) • Highest prevalence: Trelawny(58.0%) , St James (47.0%) , Kingston (46.1%) • Lowest prevalence: Manchester (32.2%), St Mary (34.5%), St Ann (36.6%)

  15. Prevalence of Obesity (BMI ≥30) by Parish (Males) p=0.064 • Highest prevalence: Hanover (22.9%) , St Catherine (22.0%), St Ann (19.5%) • Lowest prevalence: Westmoreland (2.0%), Portland (4.2%), St Thomas (7.6%)

  16. Prevalence Diabetes Mellitus(defined as FBS ≥ 7.0 mmol/l or on medication for diabetes) • Overall diabetes prevalence 11.9% (95%CI 10.5 - 13.4%) • Significantly higher prevalence among women 15% vs. 9% (p<0.001) • Prevalence among persons 15-74 years 10.2% (95% CI 8.9 - 11.7%) • Absolute increase of 2.3% compared to JHLS-II in 2008

  17. Prevalence of Diabetes Mellitus by Age P<0.001 for both males and females

  18. Prevalence of Diabetes by Parish (Females) Female (p=0.167) • Highest prevalence: Manchester (22%) , Westmoreland (21%), Trelawny (19%) • Lowest prevalence: St Mary (8%), St Ann (9%), Portland (12%)

  19. Prevalence of Diabetes by Parish (Males) Male (p=0.038) • Highest prevalence: Hanover (19%) , Clarendon (19%), Kingston (17%) • Lowest prevalence: St Thomas (2%), St Mary (4%), Trelawny (4%)

  20. Prevalence of Diabetes Mellitus by Rural / Urban Residence • No significant differences between rural and urban residents • 11.4% among rural vs. 12.3% among urban residents

  21. Pre-diabetes by Sex Prediabetes defined as fasting glucose of 5.6-6.9 mmol/l p<0.001 Overall 24% of persons 15 years or older have diabetes or prediabetes

  22. Definition & Classification of High BP JNC7 = The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 

  23. Prevalence of Hypertension by Sex using JNC-7 (2003) and ACC/AHA (2017) criteria JNC-7 (SBP ≥140 or DBP ≥90) ACC/AHA 2017 (SBP ≥130 or DBP ≥80) p=0.039 p=0.506

  24. Proportion of Population in Blood Pressure Categories (JNC-7 & ACC/AHA) Only 32% of Jamaican adults have normal blood pressure 2/3 of the population have elevated blood pressure

  25. Hypertension by Age and Sex (JNC7) P<0.001 for both males and females

  26. Hypertension – Rural vs Urban (JNC7) • No significant rural urban differences in the prevalence of HTN • 34.5% rural vs 33.1% urban

  27. Hypertension by Parish (JNC7) P=0.014 P=<0.001

  28. Prevalence of High Cholesterol(total cholesterol ≥5.2 mmol/l) • Estimated prevalence of high cholesterol = 18% • Higher in women compared to men 20% vs. 16%, p=0.024 Urban vs. Rural • Rural prevalence 20%; urban prevalence 16%; p=0.083 • Rural urban difference significant among females: 23% (rural) vs. 17% (urban); p=0.036

  29. Prevalence of High Cholesterol by Age P<0.001 for both males and females

  30. Hypertension and Diabetes by BMI Category BMI categories: <18.5 = underweight; 18-5-24.9 = normal weight; 25.0-29.9 = pre-obese; ≥30 = obese (units = kg/m2)

  31. Level of Awareness (%) for HTN & DM

  32. Treatment and Control (%) among Persons Aware of HTN, DM 1 Controlled calculated as proportion of those on treatment

  33. Prevalence of Heart Attack by Sex and Age • Overall prevalence of heart attack 0.4% (4.2 per 1000) • Prevalence is lower than 0.6% seen in 2008 • As expected no cases among persons <35; absence of cases in 45-54 probably due to chance given the small numbers

  34. Prevalence of Stroke by Sex and Age • Overall prevalence of stroke was 1.2% (10 per 1000) • Prevalence is slightly lower than 1.4% seen in 2008 • No cases among persons <25; high prevalence among persons ≥75 years

  35. Secular Trends among persons 15-74 years for 2001, 2008, 2017

  36. Summary / Key Findings • Prevalence of NCD risk factors remain high and appear to be increasing • More than half of the population is pre-obese/obese • 2/3 have elevated blood pressure • 1/8 have diabetes; ¼ had pre-diabetes or diabetes combined • Just under 1/5 have high cholesterol • 4/10 persons with HTN or DM unaware of their condition • Only 30% of treated persons with HTN or DM are controlled

  37. Implications • Jamaica will to continue to face challenges with complications of diabetes & hypertension, particularly heart disease, stroke & chronic kidney disease • Health care expenditure is likely to increase • May negatively impact economy due to reduced productivity among persons who are ill • Likely to see increase in dependency ratio due to more persons being unable to work

  38. Recommendations • Population wide intervention to reduce obesity, diabetes and hypertension • Jamaica Moves  programme - physical activity, healthy eating; promotion of age-appropriate health checks for NCDs and NCD awareness. • Improved socioeconomic circumstances and improved access to care • Population wide screening for hypertension, diabetes and high cholesterol to increase awareness and ensure persons are treated • Engagement of health care providers in both public and private sector to improve quality of care

  39. JHLS-III Research Team

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