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Investigating associations between rural-to-urban migration and cardiometabolic disease in Malawi: a population-level study. / Chilunga, Felix P.; Musicha, Crispin; Tafatatha, Terence et al.
In: International journal of epidemiology, Vol. 48, No. 6, 2019, p. 1850-1862.Research output: Contribution to journal › Article › Academic › peer-review
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TY - JOUR
T1 - Investigating associations between rural-to-urban migration and cardiometabolic disease in Malawi: a population-level study
AU - Chilunga, Felix P.
AU - Musicha, Crispin
AU - Tafatatha, Terence
AU - Geis, Steffen
AU - Nyirenda, Moffat J.
AU - Crampin, Amelia C.
AU - Price, Alison J.
PY - 2019
Y1 - 2019
N2 - BACKGROUND: The extent to which rural-to-urban migration affects risk for cardiometabolic diseases (CMD) in Africa is not well understood. We investigated prevalence and risk for obesity, diabetes, hypertension and precursor conditions by migration status. METHODS: In a cross-sectional survey in Malawi (February 2013-March 2017), 13 903 rural, 9929 rural-to-urban migrant and 6741 urban residents (≥18 years old) participated. We interviewed participants, measured blood pressure and collected anthropometric data and fasting blood samples to estimate population prevalences and odds ratios, using negative binomial regression, for CMD, by migration status. In a sub-cohort of 131 rural-urban siblings-sets, migration-associated CMD risk was explored using conditional Poisson regression. RESULTS: In rural, rural-to-urban migrant and urban residents, prevalence estimates were; 8.9, 20.9 and 15.2% in men and 25.4, 43.9 and 39.3% in women for overweight/obesity; 1.4, 2.9 and 1.9% in men and 1.5, 2.8 and 1.7% in women for diabetes; and 13.4, 18.8 and 12.2% in men and 13.7, 15.8 and 10.2% in women for hypertension. Rural-to-urban migrants had the greatest risk for hypertension (adjusted relative risk for men 1.18; 95% confidence interval 1.04-1.34 and women 1.17: 95% confidence interval 1.05-1.29) and were the most screened, diagnosed and treated for CMD, compared with urban residents. Within sibling sets, rural-to-urban migrant siblings had a higher risk for overweight and pre-hypertension, with no evidence for differences by duration of stay. CONCLUSIONS: Rural-to-urban migration is associated with increased CMD risk in Malawi. In a poor country experiencing rapid urbanization, interventions for the prevention and management of CMD, which reach migrant populations, are needed.
AB - BACKGROUND: The extent to which rural-to-urban migration affects risk for cardiometabolic diseases (CMD) in Africa is not well understood. We investigated prevalence and risk for obesity, diabetes, hypertension and precursor conditions by migration status. METHODS: In a cross-sectional survey in Malawi (February 2013-March 2017), 13 903 rural, 9929 rural-to-urban migrant and 6741 urban residents (≥18 years old) participated. We interviewed participants, measured blood pressure and collected anthropometric data and fasting blood samples to estimate population prevalences and odds ratios, using negative binomial regression, for CMD, by migration status. In a sub-cohort of 131 rural-urban siblings-sets, migration-associated CMD risk was explored using conditional Poisson regression. RESULTS: In rural, rural-to-urban migrant and urban residents, prevalence estimates were; 8.9, 20.9 and 15.2% in men and 25.4, 43.9 and 39.3% in women for overweight/obesity; 1.4, 2.9 and 1.9% in men and 1.5, 2.8 and 1.7% in women for diabetes; and 13.4, 18.8 and 12.2% in men and 13.7, 15.8 and 10.2% in women for hypertension. Rural-to-urban migrants had the greatest risk for hypertension (adjusted relative risk for men 1.18; 95% confidence interval 1.04-1.34 and women 1.17: 95% confidence interval 1.05-1.29) and were the most screened, diagnosed and treated for CMD, compared with urban residents. Within sibling sets, rural-to-urban migrant siblings had a higher risk for overweight and pre-hypertension, with no evidence for differences by duration of stay. CONCLUSIONS: Rural-to-urban migration is associated with increased CMD risk in Malawi. In a poor country experiencing rapid urbanization, interventions for the prevention and management of CMD, which reach migrant populations, are needed.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85077221952&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/31603469
U2 - 10.1093/ije/dyz198
DO - 10.1093/ije/dyz198
M3 - Article
C2 - 31603469
VL - 48
SP - 1850
EP - 1862
JO - International journal of epidemiology
JF - International journal of epidemiology
SN - 0300-5771
IS - 6
ER -
ID: 10425695