In this article, we report a significantly high prevalence of self-reported chronic diseases (combined) among the adult population of the Emirate of Dubai, UAE. Furthermore, our results reveal that a number of non-modifiable risk factors are associated with chronic diseases in this population. The high crude prevalence (15%) of chronic diseases found in this survey is in line with what has been reported previously across Arabian Gulf countries [19-22]. Because of logistical challenges, objective measures of chronic diseases did not provide adequate data for analysis. However, population-based self-reporting of chronic diseases has been shown to be relatively reliable [23]. Although non-communicable diseases are caused by a combination of modifiable and non-modifiable risk factors [24], our analysis was limited to non-modifiable risk factors. These characteristics are essential to understand the context, profile, and trend of non-communicable diseases among the population. Of the variables analyzed, age, gender, marital status, and nationality were found to be associated with self-reported chronic diseases as defined in our study methods.
As expected, older individuals were more likely to report higher levels of chronic diseases than younger individuals. Moreover, males were more likely to report chronic diseases than females. Since Dubai is a major metropolitan city [25], Emiratis were found to report a higher rate of chronic diseases than other nationalities in the Emirate. Interestingly, when combining age with marital status, an association was found between chronic disease and older individuals who remained unmarried, though not surprisingly. Our results confirmed that the prevalence of chronic conditions increases with age. Previous studies reported associations between sociodemographic characteristics and chronic diseases [9, 22, 26, 27]. Age has been found to be significantly associated with non-communicable diseases in many published studies in the UAE [27-29]. Other studies in the region have revealed similar findings related to the association of age with non-communicable diseases [19-21, 30]. The explanation for this observation is the cumulative effect of non-communicable diseases over time as well as the degenerative process combined with aging leading to and contributing to the development of different types of chronic diseases.
Our results revealed that nationality is one of the non-modifiable risk factors and a predictor of the report of a chronic disease. This finding has been echoed in many studies, and sometimes nationality was referred to as ethnicity [31-34]. In this analysis, we found that Emiratis had a higher likelihood of reporting a chronic disease than other nationalities when adjusting for other sociodemographic characteristics. Another study that examined diabetes and impaired fasting glycemia in the UAE revealed that these conditions were higher in Emiratis than in other nationalities [32]. Similarly, for cardiovascular diseases, a study has found that these morbidities are more prevalent in some nationalities and ethnicities than others [33]. These findings could be due to lifestyle, genetics, cultural and/or socioeconomic factors as explained elsewhere [35].
Gender was found to be another significant predictor for chronic diseases among the representative sample of DHSS 2019. Different studies have examined the gender difference in non-communicable diseases and the experience of these illnesses related to gender identity [35-38]. It is worth noting that the nature of chronic diseases differs by gender. Men are more prone to a wider range of health risks, such as hypertension, cerebrovascular disease and cardiovascular diseases [39]. On the other hand, women are more likely to report diseases related to arthritis, osteoporosis diabetes and hypertension [40]. Moreover, since men tend to adopt unhealthy behaviors, such as smoking and alcohol consumption, they are more likely to report experiencing chronic disease and poor health [35, 39].
In the current study, unmarried adults were reported to have a lower risk of chronic diseases than married and formerly married adults. However, when combining age with marital status, the relationship was reversed, and chronic disease was higher in older unmarried individuals within our population sample. Unmarried individuals who were older had a three-fold risk of reporting a chronic disease compared to older married individuals. Although published data show that, the association between chronic diseases and marital status is scarce and old [41-43], there are many published results demonstrating higher risk of mortality among unmarried individuals [44-46]. Moreover, a longitudinal study in the United States identified that marital status was associated with poor health outcomes at the oldest ages [47]. This association can be attributed to the selective effect of marriage, where marriage can sometimes reduce stress and provide social support in light of clarity in the defined roles between married couples.
It is important to acknowledge some limitations of our study. The data on having a chronic disease or not available for this study derived from individual self-reports and not from medical records. Although self-reporting is a widely used practice to reflect patient experience, it may include subjectivity as a diagnostic tool with bias and accuracy. Self-reporting might lead to under- or over reporting on some occasions. Another limitation involved in this study, the severity of the chronic disease and the existence of comorbidity were not included, and these qualifiers may better explain the status of individuals. While the DHHS was limited to the population of Dubai, we cannot generalize the results to the general population of the UAE. However, the availability of the data can be used as a strength, especially because the survey tool is valid and was conducted through well-trained surveyors. Additionally, the data can be used in the future to conduct trend and pattern analyses for monitoring Dubai population health.