The Central America Diabetes Initiative (CAMDI)
Survey of Diabetes, Hypertension and Chronic Disease Risk Factors
Belize, San José, San Salvador (Santa Tecla), Guatemala City (Villa Nueva), Managua and Tegucigalpa
CAMDI 2010
Also published in Spanish as: Iniciativa Centroamericana de Diabetes CAMDI): Encuesta de diabetes, hypertensión y factores de riesgo de enfermedades crónicas. Belice, San José, San Salavador (Santa Tecla), Ciudad de Guatemala (Villa Nueva), Managua y Tegucigalpa © Organización Panamericana de Salud, 2011 ISBN: 978-92-75-33098-2 PAHO HQ Library Cataloguing–in-Publication Pan American Health Organization The Central America Diabetes Initiative (CAMDI): Survey of Diabetes, Hypertension and Chronic Disease Risk Factors. Belize, San José, San Salvador, Guatemala City, Managua and Tegucigalpa Washington, D.C.: PAHO, © 2011 ISBN: 978-92-75-13098-8 I. Title 1. DIABETES MELLITUS 2. HYPERTENSION 3. CHRONIC DISEASE 4. RISK FACTORS 5. DATA COLLECTION 6. CENTRAL AMERICA NLM WK 810 The Pan American Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. Applications and inquiries should be addressed to Editorial Services, Area of Knowledge Management and Communications (KMC), Pan American Health Organization, Washington, D.C., U.S.A. The Project of Chronic Diseases (HSD/NC),
[email protected] from the Area of Health Surveillance and Disease Prevention and Control will be glad to provide the latest information on any changes made to the text, plans for new editions, and reprints and translations already available. © Pan American Health Organization, 2011. All rights reserved. Publications of the Pan American Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights are reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the Pan American Health Organization concerning the status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the Pan American Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the Pan American Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the Pan American Health Organization be liable for damages arising from its use. Authors: Alberto Barceló Edward Gregg Enrique Pérez Flores Roy Wong Robert Gerzoff Elizabeth Cafiero Micheline Meiners The Project of Chronic Diseases (HSD/NC),
[email protected] from the Area of Health Surveillance and Disease Prevention and Control of the Pan American Health Organization (PAHO) has been responsible for the translation, printing, and distribution of this book. This publication can be requested at:
[email protected] or
[email protected]. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
2010
The CAMDI Team Ethan Gough Englebert Emmanuel Valerie Jenkins Lorraine Thompson Luis Tacsan Chen Roy Wong Maclure Melany Ascencio Rivera Louella Cunningham Sara Rodriguez Aguilar Eduviges Sancho Jimenez José Miguel Angulo Castro María de los A Alvarado Rosales Roberto del Aguila Raul Palomo Gerardo de Cosio Patricia Orellana Manuel Ramirez Maggie Fischer Ruben Palma Elia Pineda Ileana Mayes Tamara Mancero Elizabeth León Franklin Hernández Lucy Villagra Martha Pastora Rodolfo Peña Bismark Rodriguez Lesbia Altamirano Edward Gregg Robert Gerzoff Micheline Meiners Elizabeth Cafiero Enrique Perez Flores Alberto Barceló
Belize Belize Belize INCAP/PAHO, Belize Costa Rica Costa Rica Costa Rica Costa Rica Costa Rica Costa Rica Costa Rica Costa Rica PAHO, Costa Rica El Salvador PAHO, El Salvador Guatemala INCAP, Guatemala INCAP/ PAHO, Guatemala Honduras Honduras Honduras PAHO, Honduras PAHO, Honduras PAHO, Honduras Nicaragua Nicaragua Nicaragua Nicaragua PAHO, Nicaragua CDC, USA CDC, USA PAHO, Washington DC PAHO, Washington DC PAHO, Washington DC PAHO, Washington DC
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Table of Contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Objetives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Variables and indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Methology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Population and sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Exclusion criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Survey design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Blood pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Glucose tolerance test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Lipid profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Anthropometric measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Data collection and training of interviewers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Data management and statistical analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 Appendix A: List of tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Appendix B: Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Appendix C: Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .145 Appendix D: Blood pressure and physical measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . .171
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Introduction Most developing countries of Latin America are in a stage of epidemiologic, demographic, and nutritional transition. Changes in lifestyle are associated with mass migration from the rural areas to the urban areas, the phenomena of globalization, and exchanges between cultures (1). These changes are occurring rapidly in Central America; consequently, protein-calorie malnutrition is observed most frequently in conjunction with obesity, hypertension, diabetes mellitus, and hypercholesterolemia (2). The health situation in Central America is evolving from one in which the epidemiologic profile is dominated by infectious diseases and nutritional deficiencies to an elevation of the importance of chronic non communicable diseases (NCD) as principal causes of morbidity. For example, data from around the year 2002 demonstrated that among women in Central America of 20-59 years the first cause of death is cancer of the uterus, with diabetes, stroke, and ischemic heart disease being the third, four and fifth causes respectively (2). During the same period, among those of age 60 years and older in both genders, ischemic heart disease and stroke were the first and second causes of death, respectively, while congestive heart disease and diabetes were among the five main causes of deaths (4). Furthermore, the ratio of mortality due to non communicable and communicable causes in Central America rose from 1.0 to 3.1 between the periods of 1980-1985 and 1990-1995, respectively. Despite the importance of NCD in the health profile of Central America, information on the prevalence of major chronic diseases such as diabetes and hypertension and their risk factors are not available. Obesity, physical inactivity and diet are considered major factors in the etiology of diabetes mellitus and hypertension. Obesity can contribute significantly to heart disease and resulting disabilities. For this reason, the present study examined the effects of epidemiologic transition on the health profile of various populations of Belize, Costa Rica, El Salvador, Honduras, Guatemala and Nicaragua.
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Objectives • Determine the prevalence of diabetes mellitus and hypertension in people 20 years of age and older in a sample taken from six Central American populations (urban areas of San José, Costa Rica; Santa Tecla, San Salvador, El Salvador; Villanueva, Guatemala City, Guatemala; Tegucigalpa, Honduras; and Managua, Nicaragua; and the national population of Belize). • Determine the prevalence of major risk factors diabetes and hypertension in six Central American populations.
Variables and indicators Blood pressure was classified using the criteria of the Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (4). Diabetes mellitus was diagnosed in accordance with the criteria established by the World Health Organization (5). The primary variables and respective indicators are: Classification of Blood Pressure
Systolic Blood Pressure mmhg
Diastolic Blood Pressure mmHg
Normal Normal High (Prehypertension)