|Year : 2013 | Volume
| Issue : 5 | Page : 130-136
Prevalence of diabetes and hypertension among geriatric population in a rural community of Tamilnadu
Shankar Radhakrishnan, Sangeetha Balamurugan
Department of Community Medicine, Vinayaka Missions Kirupananda Variyar Medical College, Salem, Tamilnadu - 636 308, India
|Date of Web Publication||5-Dec-2013|
Community Medicine, Vinayaka Missions Kirupananda Variyar Medical College, Chinna Seeragapadi, Tamilnadu - 636 308, Salem
Introduction: Elderly population contributed to 7% of total population of India in 2001and it will rise to 9% by 2016. In 2010,100 million people were aged above 60 years and by 2020 it will be 177 million. Ageing process is as such complex and multi-factorial. Chronic morbidities like diabetes and hypertension are becoming common health problems among the geriatric population. Aim : To assess the prevalence of diabetes and hypertension among geriatric population in a rural community of Tamilnadu. Materials and Methods: A cross-sectional study was conducted on 400 geriatric population at Attayampatti village, rural community in Salem district by using a pre-tested, semi-structured questionnaire. House to house visit was done on simple random basis. Their height and weight was measured and body mass index was calculated. The diabetic status was confirmed by using random blood sugar estimation and hypertension was assessed by using a standard sphygmomanometer apparatus. Results:The overall prevalence of diabetes among study population was 36% and the prevalence of hypertension was 59%. Among diabetes, the prevalence in males was 22% and in females it was 15%. Among hypertensives, the prevalence in males was 33.3% and in females it was 26.2%. Their mean BP was 140/100 and the mean random blood sugar was 180mgs/dl. Factors like age, BMI and smoking showed statistical significant association towards diabetes and hypertension. Conclusion:Early identification of chronic geriatric morbidities like diabetes and hypertension should be ensured through periodic screening and regular health checkups.
Keywords: Diabetes, geriatric population, hypertension
|How to cite this article:|
Radhakrishnan S, Balamurugan S. Prevalence of diabetes and hypertension among geriatric population in a rural community of Tamilnadu. Indian J Med Sci 2013;67:130-6
|How to cite this URL:|
Radhakrishnan S, Balamurugan S. Prevalence of diabetes and hypertension among geriatric population in a rural community of Tamilnadu. Indian J Med Sci [serial online] 2013 [cited 2014 Sep 2];67:130-6. Available from: http://www.indianjmedsci.org/text.asp?2013/67/5/130/122742
| ¤ Introduction|| |
Geriatric health problem is a growing concern due to increase in absolute number of geriatric people and socio-demographic changes in community. Elderly population contributed to 7% of total population in India in 2001 and it will rise to 9% by 2016. In 2010, 100 million people were aged above 60 years (70 million in 2000) and by 2020 it will be 177 million. According to an estimate they will constitute one third of total population of the world by 2050 AD. , Ageing process is as such complex and multi-factorial. Chronic morbidities like diabetes and hypertension is becoming quite a common health problem among the geriatric population. Diabetes mellitus is a common health problem in old age and it was identified that an elderly patient suffering from depression had combined physiological, psychological and social needs. Changes in lifestyle, including diet and physical activity, and the increasing numbers of elderly people are both key factors for the worldwide epidemic of diabetes. Diabetes and its complications take a major toll on the quality of life of the elderly and the health care costs of the society. Both diabetes and aging increase the risk for arteriosclerosis and cardiovascular mortality.  Rising worldwide rates of diabetes mellitus heighten the need to maintain adequate metabolic control in diabetic patients and to control for other cardiovascular risk factors, such as lipid profile disturbances, high blood pressure, and smoking habits. This is especially the case in diabetic patients who also present with hypertension, a co-morbid state that is present in at least 50% of type 1 and type 2 diabetic patients. Cardiovascular disease is present in 75% of all diabetes related deaths, and the concomitant condition of diabetes and hypertension is believed to act synergistically on elevating the risk for cardiovascular disease. Furthermore, hypertension is associated not only with an increased risk for cardiovascular mortality but also for micro-vascular complications in patients with diabetes.  Hypertension is becoming an important public health problem worldwide. A recent report on the global burden of hypertension indicates that nearly 1 billion adults (more than a quarter of the world's population) had hypertension in 2000, and this is predicted to increase to 1.56 billion by 2025. Subjects with hypertension are known to have a two fold higher risk of developing coronary artery disease (CAD), four times higher risk of congestive heart failure and seven times higher risk of cerebrovascular disease and stroke.  Hypertension has been identified as a major risk factor for the development of diabetes. Patients with hypertension are at a 2-3 times higher risk of developing diabetes than patients with normal blood pressure. Hypertension by itself is, of course, a powerful risk factor for cardiovascular morbidity and mortality as established by data from the Framingham cohort more than three decades ago. For any given level of systolic blood pressure, the occurrence of diabetes distinctly increases cardiovascular mortality.  As only very few studies have been done on assessing the prevalence of diabetes and hypertension among the geriatric population of rural India, so this study is taken to assess the magnitude of these chronic morbidities among the elderly.
Aim/objective of the study
- To assess the prevalence of diabetes and hypertension among the geriatric population in a rural area in Tamilnadu
- To study the factors influencing diabetes and hypertension among them
| ¤ Materials and Methods|| |
Study area: Attyampatti village
Study period: October 2010-December 2010
Study design: Cross sectional study
Study population: Attayampatti town panchayat has a population of 10,000 and in that the geriatric population is 800 (keeping the national average of 8%). Keeping the prevalence of diabetes and hypertension as 20% in the geriatric population and taking the confidence interval as 95% and the maximum allowable error as 4%. Applying these values in the standard formula for calculation of sample size (4 PQ/e 2 ), the study population came to 400.
Sampling: Totally 800 of them above 60 years were in the sampling frame out of which 400 are included as study subjects and those 400 were selected by using a simple random technique.
Using a pretested semi-structured questionnaire, house to house visit was done on simple random basis. Questions regarding family history, diet history including their calorie and protein consumption, their dependency status, socio-economic and occupation history and history of any chronic morbidity among elderly were taken. Their height and weight were measured and the BMI was calculated. Their diabetes status is confirmed by using a random blood sugar estimation and their hypertension is assessed by using a standard sphygmomanometer apparatus.
| ¤ Results|| |
The overall prevalence of diabetes among study population was 36% and the prevalence of hypertension was 59%. Among diabetes, the prevalence in males was 22%, and in females it was 15%. Among hypertensive's, the prevalence in males was 33.3%, and in females it was 26.2%.
Their mean BP is 140/100 and the mean random blood sugar is 180 mg/dl.
[Table 1] Shows that among diabetes, maximum number to be seen in the males, is in the age group of 78-80 years and in females maximum number to be seen is in the age group of 66-68 years. It is found that, no statistical significance was seen in the diabetes status as age increases. Among hypertensives, maximum number to be seen in the males, is in the age group of 78 years and above. In females maximum number to be seen is in the age group of 80 years and above. It is found that, statistical significance was seen in the hypertensive patients at P < 0.002, where as age increases, the prevalence of hypertension increased. Multiple logistic regression was done in [Table 2] to see the factors influencing diabetes among males and females. Among males, smoking and hypertension shows statistical significant association towards diabetes. Among females, only hypertension showed statistical significant association towards diabetes. Other factors like family size, dependency, living status of spouse, alcohol intake, diet and BMI, though showed association, but not statistically significant. Another multiple logistic regression was done in [Table 3] to see the factors influencing hypertension among males and females. Among males, diabetes and BMI shows statistical significant association towards hypertension. Among females, diabetes alone showed statistical significant association towards hypertension. Other factors like family size, dependency, living status of spouse, smoking, alcohol intake, diet and exercise, though showed association, but not statistically significant. To see the relationship between diabetes and hypertension a Pearson correlation was done in [Table 4] there was a significant correlation seen at 0.01 level between diabetes and hypertension in both sexes. BMI association was seen among diabetes and hypertension in [[Table 5] and [Table 6] and it showed that a maximum prevalence of diabetes was seen in the population with BMI 30 and above. As BMI increases, prevalence of diabetes also increases, which was found to be statistically significant at P < 0.002 and similarly the maximum prevalence of hypertension was seen in the population with BMI 35 and above. As BMI increases, prevalence of hypertension also increases, which was found to be statistically significant at P < 0.001.
| ¤ Discussion|| |
In our study, the prevalence of diabetes among males and females was 22% and 15% respectively, and that of hypertension it was 33.3% and 26.2%. It was also shown that population with BMI 30 and above, the prevalence of diabetes and hypertension increases.
Similarly, study done by Shashank et al. on the elderly rural population of Delhi, showing the prevalence of hypertension as 11.25%, and this showed a higher prevalence of hypertension in elderly persons in urban area compared to rural area, and it also showed a mean age of detecting hypertension was found to be 54.2 years, and mean age of detecting diabetes was 53.8 years.  A lessons from Jaipur heart watch by Rajeev Gupta, showed the prevalence of diabetes among asymptomatic elderly individuals was 13%. And study in rural south India showed the age adjusted rates for known diabetes among elderly subjects were unexpectedly high, considering the poor socioeconomic circumstances, decreased health awareness and decrease access to medical facilities.  A study done by Anjum et al. in Peshawar showed that the incidence of hypertension among geriatric population is 27% and the relation of normal BMI with hypertension is 34% and overweight is 58% while that of obese is 77% indicating a strong relationship of hypertension with BMI.  A study done by Swami HM et al. among the geriatric population of Chandigarh, showed the prevalence of hypertension was 82.5%, among the overweight elderly in comparison to 45.87% among non overweight or obese. Similarly the prevalence of diabetes was 15% and 9.92% in overweight and non overweight elderly.  A study done by Singh VB et al. on prevalence of hypertension among the rural geriatric population of northwest Rajasthan was 41% and in that BMI and smoking showed a significant association towards hypertension. 
Purty AJ et al. on Morbidity pattern among the elderly population in the rural area of Tamil Nadu, India found that the prevalence of hypertension 14% and that of diabetes it was 8.1%.  Parray SH et al. on Morbidity profile of geriatric population in Kashmir showed that the prevalence of hypertension was 56% and that of diabetes it ranged between 16-52%.  A Study done by Natarajan VS et al. among the elderly people in rural community in Tamilnadu, found the prevalence of hypertension among males 7.71%, and among females is 10.6%,similarly the prevalence of diabetes is 5.85% among males and in females is 4.72%.  A study done by Lena A et al. on health and social problems of elderly in Udupi taluk, Karnataka, found the prevalence of hypertension 59.1%, male 57.6%, female 60.3%, and that of diabetes 10.3%, male 11.9% and females 9%.  A study done by Chhetri MR et al., on the elderly rural population of Nepal, showed the prevalence of Diabetes among males is 21.1% and among females is 24.8%, and the prevalence of diabetes were increasing with age, even though all subjects were 60 years and above. Education, occupation and income does not show any statistical association with the prevalence, whereas BMI and exercise showed a significant statistical association.  Similarly in our study the prevalence of hypertension increases, as age increases, which was found to be statistically significant, whereas the diabetes prevalence does not showed the statistical significance with the age. A study done by Moharna PR et al., among the geriatric population in Chandigarh, showed the prevalence of hypertension as 51% and diabetes as 36% and 41% of the persons were overweight and 64% of overweight persons were hypertensives. The overweight was significantly associated with diabetes. Only 23% among the overweight were exercising regularly daily. It was found that due to inadequate control of diabetes, the long term complications such as coronary heart disease (CHD) were higher in this group. They also found out high cholesterol, hypertension, smoking and alcohol consumption were risk factors for CHD.  A study done by A Ramachandran et al. among elderly rural population of Jaipur, showed that the prevalence of hypertension among males were 50.8% and among females as 51%. It was found that 25.2% of study subjects had isolated systolic hypertension, and they found out age, smoking and BMI as significant determinants of hypertension.  Similarly in our study, smoking showed a statistically significant association towards diabetes, but not for hypertension, whereas BMI showed a statistically significant association, both for diabetes and hypertension.
In earlier years, their were very low prevalence of diabetes in rural population. A meta-analysis study by Mohan V et al. reported a very high prevalence rate in rural India, similar to those in urban Indian population. It was found that, interestingly correlation of BMI with diabetes has been observed in this study. They also stated a reverse migration of culture is taking place in Indian rural population, might be the cause for increased prevalence of diabetes,  A meta-analysis study by Gupta R et al. on trends in hypertension, found that there is a steady increase in the prevalence of hypertension in the rural population. They showed the overall prevalence of hypertension among males is 20% and among females 17%. 
| ¤ Conclusion|| |
Early identification of chronic geriatric morbidities, like diabetes and hypertension should be ensured through periodic screening and regular health check ups. Regular and repeated counseling for monitoring of physical parameters is essential for timely intervention and treatment adherence. Behavioral changes for weight reduction through dietary modification and regular exercise and avoidance of substance abuse will add quality to geriatric health.
| ¤ References|| |
|1.||Lal, Adarsha, Text Book of Community Medicine, 1st ed. New Delhi, India: CBS Publishers and Distributors 2007. p Sunder Lal P.no 615-18 |
|2.||Park's Text Book of Preventive and Social Medicine, 19th ed. Jabalpur, India: Banarsidas Bhanot Publishers;2007. p K Park 475-77 |
|3.||Dhungel S, Bista S. High blood glucose level and increased risk of mortality in critically ill patients. Nepal Med Coll J 2007;9:44-5. |
|4.||Mohan V, Sandeep S, Deepa R, Shah B, Varghese C. Epidemiology of type 2 diabetes: Indian scenario. Indian J Med Res 2007;125:217-30. |
|5.||Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: Analysis of worldwide data. Lancet 2005,365,217-23. |
|6.||In: Tunstall-Pedoe H, editor, for the WHO MONICA Project. MONICA monograph and multimedia sourcebook. Geneva: World Health Organization; 2003. P135-40 |
|7.||Joshi SR, Parikh RM. India - Diabetes capital of the world: Now heading towards hypertension. J Assoc Physicians India 2007;55:323-4. |
|8.||Rajeev Gupta et al. Hypertension epidemiology in India: lessons from Jaipur Heart Watch. Current Science 2009;97. |
|9.||Humayun A, Shah AS, Sultana R. Relation of hypertension with body mass index and age in male and female population of Peshawar. J Ayub Med Coll Abbottabad 2009;21:63-5. |
|10.||HM. Swami. An Epidemiological Study of Obesity Among Elderly In Chandigargh, IJCM. 2005;30. P 11-13. |
|11.||VB Singh. Prevalence of hypertension in geriatric population A community based study in North-West Rajasthan Indian Journal of Gerontology.2005;19:.P 135-46. |
|12.||Anil Jacob. Morbidity Pattern Among the Elderly Population in the Rural Area of Tamil Nadu, India. Turk J Med Sci 2006;36:45-50. |
|13.||Parray SH. Morbidity Profile of Geriatric Population in Kashmir (India), Indian Journal for Practicing Doctors Volume 4, No. 6, (2008-01-2008-02). |
|14.||Natarajan VS. High Prevalence of Nutritional Disorders And Nutrient Deficits In Elderly People In A Rural Community in Tamil Nadu, India. Journal of Hong Kong Geriatric Society 1995;6:40-3. |
|15.||Lena A, Ashok K, Padma M, Kamath V, Kamath A. Health and social problems of the elderly: A cross-sectional study in Udupi Taluk, Karnataka. Indian J Community Med 2009;34:131-4. |
|16.||MR Chhetri. Prevalence and determinants of diabetes among the elderly population in the Kathmandu Valley of Nepal. Nepal Med Coll J 2009;11:34-8. |
|17.||PR Moharana. Health status of geriatric population attending the preventive geriatrics clinic of a tertiary health facility. Journal of Community Medicine 2008;4 P 53-54. |
|18.||Ramachandran A. Socio-economic burden of diabetes in India. J Assoc Physicians India 2007;55:9-12. |
|19.||V Mohan. Prevalence, awareness and control of hypertension in Chennai-The Chennai urban rural epidemiology study (CURES-52) JAPI2007;55.P 326-32. |
|20.||Gupta R. Trends in hypertension epidimeology. J Hum Hypertens 2004;18:73-8. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]