Analysis Of The Burden Of Obesity And Obesity-related Chronic Diseases And Its Impact On Social Economy In Rural Areas Of Yunnan Province

Objectives:The aim of this study was to analyze the prevalence of obesity and four obesity-related chronic diseases(hypertension,diabetes,coronary heart disease and stroke),and to measure burden of four obesity-related chronic diseases in rural areas of Yunnan Province.This study also examined the influence of obesity-related chronic diseases on individual's health(quality of life),family(catastrophic health care payments and medical impoverishment)and society economy(economic burden of disease),in order to provide suggestions for the management and controlment of chronic diseases in rural areas of Yunnan Province.Methods:This study employed a cross-sectional questionnaire and health examination survey.Multistage stratified random sampling method was used to select representative sample of 4979 rural residents aged 35 and over from Yunnan Province.Collected the information about participants' demographic characteristics,annual per capital income,self-reported hypertension,diabetes,stroke and coronary heart disease(CHD),family history of obesity-related chronic diseases,information on annual disease expenditures(expenses for outpatient visits,expenses for medicine,hospitalization expenditures,nutrition fee,costs of work absence,costs of accommodation and transportation for the patient and family members during these visits),as well as the results from anthropometric measurements and fasting blood sugar and blood pressure were obtained for each participant.Physical examination included measurements of weight,height,waist circumference and hip circumference.Disability adjusted life years(DALY)was used as measure burden of four obesity-related diseases.SF-36 scale was used to assess four chronic diseases' impact on the quality of life(QOL).Catastrophic health care payments and medical impoverishment were used to assess the influences on family level.Two-step model was used to measure direct economic burden of disease,whereas human capital approach combined with DALY were applied to measure indirect economic burden.Based on population attributable risk(PAR),our study estimated the cost of hypertension,diabetes,CHD and stroke attributable to general obesity and central obesity.Logistic regression analysis was used to analyze the influencing factors of catastrophic health care payments,medical impoverishment,general obesity and central obesity.Multiple linear regression analysis was used to assess the influencing factors of QOL.Results:1.General characteristics of the study population:In the study region,a total of 5040 individuals were invited to participant in the survey.Of these,4979 consented,representing an overall response rate of 98.8%.In total,the study participants included 2474 males(49.7%)and 2505 females(50.3%).Approximate yearly income per person was ? 6985.6±6418.4.Poverty people was 813(16.4%).7.9%of participants belonged to ethnic minorities.The different age groups:35?44 age group was 1115(22.4%),45?54 age group was 1342(27.0%),55-64 age group was 1235(24.8%),?65 age group was 1287(25.8%).The different educational degree:overall adult literacy rate was 14.5%,primary school degree was 23.5%,high school or above degree was 62%.Marital status:Unmarried person was 71(1.4%)and married person was 4908(98.6%).2.The prevalence of obesity and four obesity-related diseases:(1)The prevalence of obesity:The prevalence of general obesity and central obesity was 6.8%and 38.4%,in which was 7.0%and 30.5%among males,whereas was 6.5%and 46.2%among females.The prevalence of central obesity in females was higher than in males(P<0.01).The ethnic minority participants had lower prevalence of general obesity and central obesity than the Han majority.Whereas the prevalence of general obesity and central obesity increased with age(P value for trend<0.01),the prevalence of central obesity decreased as the level of education increased(P value for trend<0.01).The results of multiple logistic regression indicated that people with higher socioeconomic status,good housing facilities,heaver life pressure and take in more fat and salted products had higher risk of being general obese,whereas people with lower level of education,lower socioeconomic status,and heaver life pressure were more likely to be central obese.(2)The prevalence of four obesity-related diseases:The overall prevalence of hypertension,diabetes,coronary heart disease(CHD)and stroke was 35.3%,9.9%,3.8%and 1.7%,respectively.The prevalence of hypertension,diabetes,CHD and stroke was 34.1%,10.6%,3.8%and 2.2%among males,whereas was 36.4%,9.1%,3.8%and 1.2%among females.The prevalence of stroke in males was higher than in females(P<0.01).The prevalence of four obesity-related diseases increased with age increased(P value for trend<0.01),whereas the prevalence of hypertension decreased as the level of education increased(P value for trend<0.01).The prevalence of hypertension and CHD among poverty people was higher than non-poverty people(P<0.01).(3)The relationship between obesity and four obesity-related chronic diseases:Obese people as expected had higher risk of the aforementioned four obesity-related diseases than their counterparts.After adjusting for other confounding factors,the risk of general obese people with hypertension,diabetes,CHD and stroke was non-obese people's 1.7,3.8,3.5 and 4.7 times.The risk of central obese people with hypertension,diabetes,CHD and stroke was non-central obese people's 2.2,1.9,1.6 and 2.1times(P<0.05).Based on population attributable risks,our study estimated the prevalence of hypertension,diabetes,CHD and stroke accounted for 4.5%,16.0%,14.5%and 20.1%attributable to general obesity,respectively,as well as,31.5%,25.7%,18.7%and 29.7%attributable to central obesity,respectively.3.The burden of four obesity-related chronic diseases:The mortality rates of hypertension,diabetes,CHD and stroke was 207/million,132/million,679/million and 1357/million.The YLL/1000 due to hypertension,diabetes,CHD and stroke was 2.4,1.9,8.5 and 16.7,respectively.The YLD/1000 due to hypertension,diabetes,CHD and stroke was 0,3.3,15.0 and 4.4,respectively.The DALY/1000 due to hypertension,diabetes,CHD and stroke was 2.4,5.2,23.5 and 21.1,respectively.The DALY and YLD due to CHD is the highest among four diseases,whereas the YLL due to stroke is the highest.The DALY of hypertension and diabetes in females was higher than in males.The DALY of CHD and stroke in males was higher than in females.The DALY of stroke attributable to general obesity and central obesity is the highest.The DALY of four diseases attributable to general obesity in males was higher than in females,whereas,the DALY of four diseases attributable to central obesity in females was higher than in males.4.The influences of four obesity-related diseases:(1)On the individual level:Compared with healthy group,the patients with hypertension had lower scores in PF,RP,BP,SF,RE,GH,PCS and MCS(P<0.05),the patients with diabetes had lower scores in PF,RP,BP,VT,RE,GH and PCS(P<0.05),and the patients with CHD and stroke had lower scores in the all scores of dimensions(P<0.05).Multiple linear regression analysis indicated that sex,age,level of education,income,hypertension,diabetes,CHD and stroke were the influence factors of physical comprehensive score,as well as,sex,age,level of education,income,CHD and stroke were the influence factors of MCS.The scores of PCS and MCS in people with higher income and level of education were higher than normal residents.The scores of PCS in the study population with diabetes were lower than normal residents.In addition,the scores of PCS and MCS in the residents with hypertension,CHD and stroke were lower than normal residents.The scores of PCS and MCS in females were lower than in males(P<0·01).(2)On the family level:The overall incidence of catastrophic health care payments(CHP)and medical impoverishment(MI)was 30.5%and 25.2%.The incidence of CHP for hypertension,diabetes,CHD and stroke was 25.4%,39.4%,39.8%and 47.0%,respectively,and the incidence of MI was 19.8%,35.7%,34.0%and 42.2%,respectively.Hypertension,diabetes,CHD,stroke,per ca pita income and age were the risk factors of CHP and MI.The higher per ca pita income was the protective factor of CHP and MI,whereas the family with elderly members and suffered from hypertension,diabetes,CHD,and stroke were more likely to occur CHP and MI(3)On the social level:Mean unit economic burden of the four chronic diseases was 6667.4Yuan,9126.1 Yuan,9270.0Yuan and 16187.2Yuan,respectively.Of this,the per ca pita direct cost was 6634.6Yuan,9054.9.1 Yuan,8948.4Yuan and 15898.5 Yuan,respectively.The per ca pita indirect cost was 32.8Yuan,71.21 Yuan,321.6Yuan and 288.7Yuan,respectively.The total costs of illness were ?108 185.2 million for hypertension,?41 529.5 million for diabetes,?16 192.0 million for CHD,and ?12 649.0 million for stroke.The economic burden of four chronic diseases in males was higher than in females(P<0.01).The total costs of four obesity-related diseases were ?178555.7million,accounting for 13%of the total GDP in Yunnan province.5.The influence of obesity:The cost of the four chronic diseases attributable to general obesity was ?8157.5 million,?6876.6 million,?3491.7 million,and ? 2740.2 million,respectively,as well as,the cost of the four chronic diseases attributable to central obesity was ?34370.2 million,? 10696.1 million,?3232.4million and ?3177.0 million,respectively.The total costs attributable to general obesity was ? 21266.0 million,accounting for 1.6%of the total GDP.The total costs attributable to central obesity was ?51475.7 million,accounting for 3.8%of the total GDP in Yunnan Province.Conclusions:1.The prevalence of obesity in rural of Yunnan Province is under the average level of China.The prevalence of hypertension is the highest among the four chronic diseases.Obesity carried a high risk of diabetes,hypertension,CHD,and stroke.In particular,stroke was highly correlated with obesity whereas hypertension was highly correlated with central obesity.2.The burden of the four diseases from highness go to lowliness in turn was CHD,stroke,diabetes and hypertension.The burden of the four chronic obesity-related diseases attributable to central obesity was higher than general obesity.In particular,the burden of stroke attributable to obesity was the highest among the four diseases.3.The obesity-related diseases had a substantial impact on rural areas of Yunnan Province.On the individual level:reduced people' QOL.On the family level:be liable to lead to the catastrophic health care payments and medical impoverishment.On the social level:the economic burden is huge.4.The hospitalization was the largest driver of medical costs.The economic burden of hypertension attributable to central obesity was higher than general obesity.In particular,the economic burden of stroke attributable to obesity was the highest among the four diseases.Effective measures from individual,family and social economy are indispensable to take action which to reduce the prevalence of obesity and obesity-related diseases:Promote awareness on dangers of obesity,especially central obesity.Interventions to curb rising obesity rates must be applied to prevent obesity-related diseases.Complete the Hierarchical medical system,Dual referral system and the Union hospitals.Successful prevention of obesity would control the number of people with obesity-related diseases and in turn lessen the influence on the individual,family and social economy.