Abstract

Introduction The rapidly growing public health burden of cardiovascular disease and diabetes in low- and middle-income countries threatens the progress expected by many countries’ effort to combat endemic infectious diseases and achieve good health and wellbeing (SDG3). Specifically, in South Africa the burden of hypertension and diabetes is a preventable but still neglected public health issue, causing a large number of premature deaths among men and women. There are very few population-based studies examining the distribution of risk factors and the combined burden of hypertension and diabetes prevalence in South Africa to inform an effective public health response.
Objectives This study investigates potential gender disparities in the co-existence of hypertension and diabetes prevalence and provincial variation in South Africa in 2016, adjusting for individual level demographic, behavioural and socio-economic variables, while allowing for spatial autocorrelation and adjusting simultaneously for the hierarchical data structure and risk factors.
Methods The study sample was based on participants aged ≥15 years from the 2016 South Africa DHS. Hypertension was defined as blood pressure ≥ 140/90 mmHg or self-reported health professional diagnosis or on antihypertensive medication and diabetes was defined as self-reported health professional diagnosis or on diabetic medication. Bayesian geo-additive regression modelling investigated the association of various socio-economic factors on the prevalence of both hypertension and diabetes across SA’s nine provinces while controlling for the latent effects of geographical location.
Results The prevalence of hypertension, diabetes, and combined hypertension and diabetes were 48.2% (4212 of 8679), 4.5% (458 of 10255) and 3.8% (314 of 8195) successively in the DHS in 2016. The prevalence of hypertension increased with age and was significantly higher in male, in people of coloured ethnic group, in overweight and obese, in people with high blood cholesterol and varied with geographical location. Diabetes prevalence increased with age and was significantly higher in male, in overweight and obese and in people with high blood cholesterol. The co-existence of the prevalence of both combined hypertension and diabetes was significantly higher in male, in overweight and obese and in people with high blood cholesterol, in people with heart attack/angina and increased with age.
Conclusion The findings can inform public health policy and decision making regarding the allocation of public resources to tackle the growing burden of hypertension and diabetes in South Africa, particularly in the most affected areas and subgroups of the population. Public health education aiming at the prevention of CVDs should target both ailments at the same time as cost effective measure to achieve SDG3.