| ObjectiveHypertension is most important risk factor of cardiovascular disease,and the prevalence of hypertension is high in China now,yet the awareness,treatment and control are still low.As the largest city in Northwest of China,Xi'an,has distinct cultural behaviors where the staple food is made from flour and the pace of life is slower.The cardiovascular disease has become the leading cause of death in both urban and rural area,however,little information was available on the prevalence and control of hypertension among adults in Xi'an..World health organization has advocated smoking,alcohol drinking,health diet and physical activity?so called health behavior?are key in the management of cardiovascular disease in primary health care center.Previous studies have investigated the relationship between health behavior and the prevalence of hypertension,little information was available on the associations of health behavior and awareness,treatment and control of hypertension,especially among adults in Xi'an.With investigating the prevalence and control of hypertension and health behaviors among adults in all districts and counties in Xi'an,the purposes of this study were to know the status of the prevalence,awareness,treatment and control of hypertension and their distributions among the adults,and to analyze the status of health behaviors?including diet,physical activity,smoking and alcohol drinking?,especially to explore the risk factors of dietary patterns and physical activity.Base on these,the effects of health behaviors on prevalence and control of hypertension were comprehensively analyzed with the structural equation model.The results of this study could provide important basic data to make the realizable goals of prevention and control of hypertension for adults in Xi'an,and provide scientific references for guide the residents to prevent and control of noncommunicable diseases through changes of health behaviors.It is realistic significance to promote the work of the prevention and control of hypertension and to improve the levels of prevention and control of hypertension among adults in Xi'an.Further,it could provide references to make reasonable diet and nutrition improvement policy,popular fitness plan and so on for the government,and it can promote the health literacy level and health conditions of the population.MethodsFrom October to December 2013,using a multiple-stage sampling method,we selected8147 Chinese participants aged 18 years or older and who had lived for at least six months in their current residence from all 14 districts and counties in Xi'an with strict inclusion and exclusion criteria.Those who lived in institutionalized area and those who were pregnant or who were unable to communicate effectively were excluded from the sample.The questionnaire developed by Chinese Center for Disease Control and Prevention for‘China Noncommunicable Disease Surveillance'was used to collect data on participants'social-demographic,health behaviors?including diet,physical activity,smoking and alcohol drinking?,and self-reported history of hypertension and so on by trained staff.With semi-quantitative food frequency questionnaire,the frequency and dose of foods eaten by participants were obtained.The Global Physical Activity Questionnaire,which covered high-and moderate-intense domain for work,travel and high-and moderate-intense domain for recreational activity,was used to assess the duration of physical activity per week and per day.Questions on sedentary behaviors were asked time spent on watching TV,computer use,phone use and reading.Three consecutive times of systolic and diastolic blood pressure were measured by standardized mercury sphygmomanometers;the mean of the latter two measurements was used for analysis.Descriptive statistics were used to analyze the social-demographics and physical measurement.Adjusted with complex survey weight,the Rao-Scott?2 test was to compare the differences of prevalence,awareness,treatment and control of hypertension in different population.With standardized data of the amount of food consumption,the dietary patterns for residents in Xi'an were identified with explorary factor analysis and the number of factors was determined by parallel analysis.After computing the tertiles of every dietary pattern,the Wilcoxon or K-W test was used to compare the differences of lowest,middle and upper tertile group of dietary patterns in different population,and the ordinal logistic regression model was to assess the associations between dietary patterns and the social-demographics.Adjusted with complex survey weight,descriptive statistics were used to analyze different type of physical activity per week and sedentary behaviors per day of residents in Xi'an.After comparing the different levels of physical activity in different population with Wilcoxon or K-W test,the ordinal logistic regression model was used to analyze the associations between physical activity and the social-demographics.In different smoking,alcohol drinking,dietary patterns,physical activity and sedentary behavior groups,the status on prevalence,awareness,treatment,and control of hypertension were analyzed.Further,the associations between health behaviors and the prevalence,awareness,treatment and control of hypertension were explored by logistic regression and Structural Equation Model,respectively.Results1.A total of 8401 participants aged 18 years or above were recruited in the study.After data clean,8147 participants were included in the analysis with effective rate 97.0%.After adjusted with complex survey weight,there were 48.6%participants being men?women:51.4%?and 50.5%participants living in the urban area?rural area:49.5%?.The mean age of the participants was 41.1?95%CI:41.0,41.2?years old.The majority of participants graduated from junior high school?39.8%?,were married/cohabited?77.4%?and were manual workers?47.8%??2.The prevalence,awareness,treatment and control of hypertension in Xi'an were21.5%?95%CI:20.1%,22.9%?,63.9%?95%CI:60.8%,66.9%?,48.3%?95%CI:44.9%,51.8%?and 18.0%?95%CI:15.4%,20.6%?,respectively.The treatment and control of hypertension in urban area were 53.1%and 24.4%,which were higher than those in rural area?treatment:44.0%,control:12.1%;all P<0.05?.The awareness,treatment and control of hypertension in men were 58.2%,43.2%and 15.5%,which were lower than those in women?awareness:69.2%,treatment:53.2%,control:20.3%;all P<0.05?.Among participants,28.0%were smokers and 2.7%were ex-smokers;the smoking in men was 56.5%,significantly higher than that in women?1.0%,P<0.05?;11.1%were alcohol drinkers with 21.0%in men which was also higher than that in women?1.6%,P<0.05?.The awareness,treatment and control of hypertension in smokers were 56.1%,38.2%and 13.1%?all P<0.05?,which were lower than those in nonsmokers,and there was no significant difference for the prevalence of hypertension in smokers and nonsmokers?smokers:21.9%,nonsmokers:20.5%;P<0.05?.The prevalence of hypertension in alcohol drinkers was 25.8%,higher than that in non-drinkers?20.9%?,and the awareness,treatment and control of hypertension in alcohol drinkers were 50.5%,33.9%and 12.6%which were also lower than those in non-drinkers?all P<0.05?.Furthermore,the prevalence,awareness,treatment and control of hypertension were increased with age,and more comorbidities?except control?.And the awareness,treatment and control of hypertension were higher in those who were retired?all P<0.05?.3.Among adults in Xi'an,three major dietary patterns were identified with exploratory factor analysis and labeled as animal foods,beverage,and vegetarian patterns,with corresponding eigenvalue 1.503,1.422 and 1.393,and totally explaining 43.18%of dietary intake variance.The results of ordinal logistic regression model showed that score of animal foods pattern was higher in those who were 45-54 years old,men,being single and retired,yet,was lower in those who lived in urban area and who combined with both diabetes and dyslipidaemia.Also,score of animal foods pattern was increased by higher educational level.Score of beverage pattern was increased by age,was higher in those who lived in urban area and who combined with both diabetes and dyslipidaemia,yet,was lower in those who were single and manual labors.Score of vegetarian patterns was higher in those who were men and being separated/divorced/widowed,and it decreased by higher educational level.4.The mean energy of physical activity was 4041.8?95%CI:3661.9-4421.6?MET-min per week for residents in Xi'an,with corresponding 862.5?95%CI:783.2-942.8?min,which included 2583.8?95%CI:2304.1-2863.4?MET-min for work domain,corresponding 525.0?95%CI:468.5-581.5?min.Among them,52.1%was from work domain?high-intense:9.2%,moderate intense:42.9%?,and it was less than 15%from high-intense and moderate intense recreational activity.According to WHO recommendation,15.6%of participants were not more than 600 MET-min/week.Self-reported sedentary time was totally about 5hours?mean:318.8min,median:292.1min?per day for participants,including about 4hours?mean:239.4min,median:208.7min?in leisure time.The results of ordinal logistic regression model showed high level of physical activity was less in those who were men and retired,and more in those who lived in urban area and were separated/divorced/widowed.Further,the high level physical activity decreased with the increment of age.5.The risk factors of the prevalence of hypertension were elder men,being retired,overweight/obesity,central obesity,having comorbidities,alcohol drinkers?OR=1.32,95%CI:1.08-1.62?and higher score of animal foods pattern(middle(P33.3?score<P66.6):OR=1.09,95%CI:1.02-1.23;upper(score?P66.6):OR=1.11,95%CI:1.03-1.26),and the protective factors were having higher educational level,being single and underweight.The risk factors of the awareness of hypertension was middle level of physical activity?OR=0.66,95%CI:0.45-0.96?,and the protective factors were elder men,having higher educational level,being retired and having comorbidities.The risk factors of the treatment of hypertension were alcohol drinkers?OR=0.70,95%CI:0.51-0.97?and higher score of vegetarian patterns?upper:OR=0.77,95%CI:0.61-0.99?,and the protective factors included elder men,living in urban area,being retired and having comorbidities.The risk factors of the control of hypertension was obesity?OR=0.63,95%CI:0.42-0.94?,and the protective factors were elder men,living in urban area,having higher educational level and combined with dyslipidaemia only.Structural equation model was used to analyzed the associations between health behaviors and the prevalence,awareness,treatment and control of hypertension.There were direct effects of alcohol drinking on the prevalence and awareness with total effect0.143 and-0.155,respectively;Also,the direct effects of sedentary behaviors were found on the prevalence and awareness with total effect 0.231 and-0.189,respectively;Similarly,there were indirect effects of smoking,animal foods pattern,beverage pattern,vegetarian pattern and physical activity on the prevalence,with corresponding effect 0.029,0.008,-0.010,0.054 and-0.042,and the indirect effects of animal foods pattern on the awareness and treatment,with total effect-0.016 and-0.008,respectively;Furthermore,the direct effect of animal foods pattern was found on the control?effect:-0.011?,and the direct effect of physical activity and sedentary behavior on the control with effect-0.222 and-0.141.Conclusions1.The prevalence of hypertension was high among adults in Xi'an,with suboptimal awareness,treatment and control rates.2.Among adults in Xi'an,three major dietary patterns were identified and labeled as animal foods,beverage,and vegetarian patterns,which were associated with different social-demographics.3.For residents in Xi'an,the main physical activity was from work domain and the proportion of recreational activity was low.Furthermore,the sedentary time was long,especially the long time on sedentary behavior in leisure time,and the proportion was high for residents who were not meet the WHO recommendation.4.The prevalence,awareness,treatment and control were associated with health behaviors.Therefore,to improve the control of hypertension among adults,health behaviors were emphasized on comprehensive measures,including health diet,smoking cessation,reducing intake of beverage and alcohol drinking,physical activity encouragement and decreasing sedentary time.Innovation?1?It was the first time to investigate the prevalence,awareness,treatment and control of hypertension among adults in Xi'an,which covered all districts and counties with large and representative sample size.And it could provide important basic data for making the realizable goals of prevention and control of hypertension for adults in Xi'an,and have very realistic significance.?2?It was leading to analyze the status of health related behavior?including smoking,alcohol drinking,diet and physical activity?,especially to explore the risk factors of dietary patterns and physical activity.The results could provide references for guide the residents to prevent and control of noncommunicable diseases through changes of health behaviors.It also could provide references to make reasonable diet and nutrition improvement policy,and popular fitness plan for the government,and it had reference value for improving health literacy level and health conditions of the population.?3?Using structural equation model to analyze the effects of health-related behaviors on prevalence and control of hypertension,it provided references for the study of risk factors of hypertension and for making the stratigies for prevention and control of hypertension. |
PDF Full Text Request