Diabetes and hypertension are among the leading causes of death in Bangladesh. This study examined diabetes and hypertension-free life expectancy, the effect of either disease and the aggregate effect of both diseases on healthy life expectancy in Bangladesh. We utilized data from Bangladesh sample vital statistics, 2018 for mortality, and Bangladesh demographic and health survey 2017-18 for diabetes and hypertension. Sullivan method has been employed to estimate age-specific hypertension and diabetes-free life expectancy. Altogether, 6% of the people lived with both diabetes and hypertension. The life expectancy free of both diseases is 56.6 years. Life expectancy without either of the diseases is 36.9 years. The prevalence of hypertension is higher than diabetes. The hypertension-free life expectancy is 40.4 years, and the diabetes-free life expectancy is 53.2 years. Female suffers more from the aggregate effect of the two chronic diseases. However, female suffers more from hypertension, and male suffers from diabetes. Diabetes and hypertension affect a considerable proportion of life of the population in Bangladesh. Policy actions are needed to guide for prevention and treatment of both diseases with a specific focus on women.
Article
The burden of diabetes and hypertension on healthy life expectancy in Bangladesh
https://doi.org/10.21203/rs.3.rs-2451585/v1
This work is licensed under a CC BY 4.0 License
Journal Publication
published 04 Apr, 2024
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Diabetes
hypertension
life expectancy
healthy life expectancy
Diabetes-free life expectancy
Hypertension-free life expectancy
The world has experienced a remarkable increase in life expectancy from less than 52 years to over 72 years between 1960 and 2019 1. Today, we expect to live much more than twice as our ancestors. Nevertheless, the situation is not identical for healthy life expectancy. Healthy life expectancy adds a quality dimension to the quantity of life by splitting life expectancy into years lived with disability or ill health and years lived free of disability or healthy. It measures whether the increase in life expectancy experienced by most countries worldwide are years of healthy life or simply extending the lives of the feeble 2. Over the years, the world has experienced an epidemiological transition. The epidemiological transition marks a shift of significant causes of death from acute infectious diseases to chronic manmade diseases 3. As a result, people are living longer with ill health and diseases. In this situation, it is essential to see increased life expectancy from the quality dimension following the quantity dimension.
In Bangladesh, life expectancy has increased from 45 years in 1960 to 73 years in 2019 1. This improvement is a resultant effect of demographic and epidemiological transition. As a result, the disease pattern of the country has shifted from infectious to chronic diseases. Ten of the fifteen major causes of death in Bangladesh are chronic degenerative diseases, where diabetes and hypertension are significant among them 4.
Diabetes is characterized by elevated blood glucose, leading to severe damage to blood vessels, the heart, kidneys, eyes, and nerves. Usually, in adults, the most common is type 2 diabetes, when the body becomes resistant to insulin or does not make enough insulin. Worldwide, around 422 million people have diabetes, with 1.5 million deaths directly attributed to it 5. Around 8% of the total population of Bangladesh have diabetes in the pooled analysis, nearly 7.3% of males and 6.7% of females 6. On the other hand, hypertension (elevated blood pressure) is a severe medical condition that significantly increases the risks of heart, brain, kidney, and other diseases. Around 1.28 billion adults aged 30–79 years have hypertension, a significant cause of premature death worldwide 7. Approximately twenty percent of adults and 40–65% of older adults have hypertension in Bangladesh 8. In this situation, it is necessary to estimate how much these two diseases affect the life expectancy and healthy life expectancy of the population of Bangladesh.
In Bangladesh, several studies have been conducted regarding healthy life expectancy and the relative contribution of different diseases and disabilities to the healthy life expectancy of the population. One study of healthy life expectancy and its correlates to self-rated health has shown that the perceived health of the population improved between 1996 and 2002 9. Urban and rural areas in Bangladesh have shown different levels of mortality and disability. Bangladesh's rural areas of Bangladesh have experienced higher mortality and morbidity 10. Another study on disability-free life expectancy in Bangladesh observed gender differences in disability-free life expectancy of old ages in Bangladesh and suggested that women have each disability and at least one disability is significantly higher percentages than men 11. At all ages, and in both numbers and proportion, women have longer life expectancy but shorter DFLE than men. Only one study has been conducted to address the relative contribution of hypertension to healthy life expectancy and observe gender differences in hypertension-free life expectancy in Bangladesh 12. However, no study has yet been conducted about diabetes-free life expectancy. The aggregate effect of diabetes and hypertension is analyzed to know how these two diseases affect people's healthy life expectancy. Diabetes and hypertension are related to each other Diabetes damages arteries and targets hardening, called atherosclerosis 13. That can cause high blood pressure. The risk factor of both diseases is related two each other. As a result, people often suffer from two diseases together. On this background, this study aimed to address the following questions:
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What is the relative contribution of diabetes to healthy life expectancy in Bangladesh?
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What is the relative contribution of hypertension to healthy life expectancy?
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What is the relative contribution of either diabetes or hypertension to healthy life expectancy?
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What is the relative contribution of both diabetes and hypertension to healthy life expectancy?
Data Source
Age-sex-specific mortality rates (nmx) were extracted from published Bangladesh sample vital statistics of 2018 14. Bangladesh Bureau of Statistics (BBS) initiated the Sample Vital Registration System (SVRS) in 1980 to determine the population change during the intercensal periods. Since the 2013 SVRS, Integrated Multi-Purpose Sample (IMPS) Design has also been followed 14. The vital events (e.g., birth, death, marriage, divorce, migration) in the sample area are collected through a dual recording system proposed by Chandrasekaran and Deming 15. Under a dual record system, vital events are collected (when they occur) by a locally recruited female registrar termed as Local Registrar (System 1). Under a second system (System 2), from the same area, another group of officials from the BBS also collect the data independently. With the filled-in questionnaires from the two systems, data are matched in the headquarters by pre-designed matching criteria. The demographic rates and ratios are estimated following Chandrasekaran and Deming's procedure. In order to find denominators for the demographic parameters, a detailed household survey is conducted at the beginning of every year, covering essential household and population characteristics. In 2018, 297233 households were surveyed from 2012 primary sampling units (PSUs). The total population was 1259744, where 630591 were males and 629153 females.
On the other hand, the age-sex-specific prevalence of hypertension and diabetes was obtained from Bangladesh demographic and health survey (BHDS), 2017-18 16. BDHS 2017-18 is the seventh type undertaken in Bangladesh as a part of an international program of measures DHS 16. The sample for the BDHS is nationally representative, and a detailed methodology will be found elsewhere in report 16. The BDHS follows two-stage stratified sampling with a response rate of 98.8%. Blood pressure (BP) and blood glucose (BG) measurement testing were collected from men and women aged 18 years and above in the subsample of 1/4 of the households. All men and women identified as eligible for BP and BG measurements (14704) were contacted and had the test explained to them, and testing was taken for those who consented. The measurements were missing for 12.1% of the respondents (16.6% for men and 8.4% for women) for BP. The sample size was 12926 (5583 for men and 7342 for women) for BP. On the other hand, 82.3% (86.3% for women and 77.4% for men) of the respondents had their BG tested. The final sample size for BG stood at 12100.
Estimation of Hypertension and Diabetes
The LIFE SOURCE® UA-767 Plus BP monitor was used to measuring blood pressure in the BDHS survey 16. During the interview, three measurements of systolic and diastolic blood pressure (measured in millimeters of mercury [mmHg]) were taken at least 5 minutes between measurements, using a digital oscillometric blood pressure measuring device with automatic upper-arm inflation and an automatic pressure release. The mean of the second and third measurements classified individuals with hypertension. Respondents whose blood pressure fell into two categories based on their mean systolic and diastolic levels were classified according to the highest blood pressure category. If the third measurement was missing, the second measurement was considered the mean. The first measurement was considered the average if the second and third blood pressure measurements were missing. Individuals were classified as hypertensive: if they had average systolic blood pressure (SBP) level of 140 mmHg or above, they had average diastolic blood pressure (DBP) level of 90 mmHg or above, or they were currently taking antihypertensive medication.
The diabetes status was calculated based on the fasting plasma glucose (FPG) level. The HemoCue Glucose 201 DM system with plasma conversion was used to test a drop of capillary blood obtained from consenting eligible respondents from the middle or ring finger after fasting overnight. The system automatically converted the fasting whole blood glucose measurements taken in the survey to FPG equivalent values. If individuals had a fasting blood glucose (FBG) equivalent level of 7 mmol/L or above or currently taking prescribed medication for their high blood glucose or diabetes were considered as having raised blood glucose or diabetes. We also estimated the prevalence of any diabetes or hypertension (if the individual suffered from any of two diseases); the prevalence of both diabetes and hypertension (if both were present simultaneously).
Estimation of life expectancy and healthy life expectancy
Using age-specific central death rate (mx), we calculated the probabilities of dying using the following formula 17:
Equation 1:\({q}_{x}=\frac{n.{m}_{x}}{1+\left(n-{a}_{x}\right).{m}_{x}}\)
Where n is the length of the age group, mx is the central death rate, and ax is the mean number of person-years lived in the interval x to x + n by those dying in the interval. We used ax equals 0.5. Details methodology of life table is available 17. For instance, we followed the steps given in Health Expectancy Calculation by the Sullivan Method: A Practical Guide 18. The following equation calculated hypertension-free life expectancy (HFLE) and diabetes-free life expectancy (DFLE).
Equation 2
Where lx refers to the number of survivors at age x, Lx refers to the person-years lived for the age interval x, Hx refers to the prevalence of hypertension-free for the age interval x, and Dx refers to the prevalence of disability-free for the age interval x. We also calculated the difference in life expectancy by gender. The 95% confidence interval (95% CI) was calculated using Z-test, where p < 0.05 was considered significant.
Probability of death, the prevalence of hypertension and diabetes
The probability of age-specific probability of dying and life expectancy are presented in Fig. 1. It is observed that the immediate risk of mortality at any age follows an exponential curve with age. The probability of dying is high at an early age and increases with aging. Life expectancy also varies with age. At ages 15–19, life expectancy ranges from 67 to 71 years, while at ages 1–4 years, it ranges from 69 to 72 years. The life expectancy of ages 1–4 years is higher than that of 0–1 year. Besides this, all life expectancy decreases with age as mortality increases exponentially.
Table 1 represents the prevalence of hypertension and diabetes among the adult population in Bangladesh in 2017-18. The prevalence of hypertension is 63.5%. Females have a higher percentage of hypertension prevalence (68.8%) than males (57.3%). The prevalence of hypertension increased with age and was highest in ages 80 or above. The prevalence of diabetes is 13.3% in Bangladesh. Males have a higher percentage of diabetes than females (15.3%, 11.4%). Diabetes is most prevalent among males and females in the middle age group (50–54).
| Age group | Hypertension | Diabetes | Either hypertension or diabetes | Both hypertension and diabetes | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Male | Female | Total | Male | Female | Total | Male | Female | Total | Male | Female | Total | |
| 15–19 | 10.6 | 5.0 | 6.8 | 5.7 | 2.9 | 3.8 | 15.7 | 7.8 | 10.3 | 0.0 | 0.0 | 0.0 |
| 20–24 | 12.8 | 7.6 | 9.5 | 5.1 | 3.7 | 4.2 | 16.3 | 11.4 | 13.1 | 1.8 | 0.1 | 0.6 |
| 25–29 | 11.5 | 14.0 | 13.0 | 3.6 | 5.6 | 4.9 | 14.0 | 18.3 | 16.7 | 0.7 | 1.1 | 1.0 |
| 30–34 | 16.8 | 21.3 | 19.5 | 6.9 | 8.0 | 7.6 | 22.0 | 25.7 | 24.3 | 1.1 | 3.2 | 2.4 |
| 35–39 | 22.1 | 31.4 | 27.0 | 8.8 | 11.6 | 10.3 | 28.6 | 38.4 | 33.8 | 3.1 | 4.6 | 3.9 |
| 40–44 | 22.0 | 37.3 | 30.3 | 13.7 | 12.5 | 13.0 | 31.3 | 44.1 | 38.3 | 5.2 | 5.9 | 5.6 |
| 45–49 | 28.3 | 43.4 | 36.9 | 11.7 | 15.2 | 13.6 | 34.2 | 49.7 | 43.0 | 6.0 | 9.2 | 7.8 |
| 50–54 | 34.9 | 47.5 | 40.8 | 17.9 | 17.3 | 17.6 | 45.8 | 54.2 | 49.7 | 7.0 | 11.8 | 9.3 |
| 55–59 | 37.6 | 51.0 | 45.0 | 14.0 | 16.8 | 15.6 | 45.2 | 55.2 | 50.7 | 7.3 | 11.8 | 9.8 |
| 60–64 | 43.6 | 54.0 | 48.6 | 18.3 | 15.2 | 17.0 | 53.0 | 60.2 | 56.4 | 9.3 | 11.0 | 10.1 |
| 65–69 | 48.3 | 55.0 | 51.2 | 16.4 | 13.3 | 15.0 | 55.6 | 59.9 | 57.5 | 11.3 | 9.2 | 10.4 |
| 70–74 | 51.0 | 52.7 | 51.7 | 19.3 | 15.5 | 17.8 | 57.9 | 58.4 | 58.1 | 12.0 | 9.4 | 10.9 |
| 74–79 | 44.8 | 62.7 | 52.6 | 12.9 | 14.8 | 13.8 | 51.8 | 67.2 | 57.9 | 7.1 | 11.5 | 9.0 |
| 80+ | 57.3 | 68.8 | 63.5 | 15.3 | 11.4 | 13.3 | 64.9 | 73.6 | 69.4 | 9.0 | 8.1 | 8.5 |
The percentage of the population with either hypertension or diabetes is 69.4. Again, females outnumbered males in the prevalence with a difference of 8.7. The total population of Bangladesh with both hypertension and diabetes is 8.5%. In this case, males have a higher percentage than females, 9% for males and 8.1% for females.
Hypertension-free life expectancy
Table 2 presents hypertension-free life expectancy in Bangladesh with a 95% confidence interval. Males have more hypertension-free life expectancy (42 years) than females (38.8 years). It is coherent with the previous Table 1, as we have seen that the prevalence of hypertension is higher among females. The percentage of years lived with hypertension is 32.8 years.
| Age | Hypertension Free Life Expectancy (95% CI) | % of Years Lived with Hypertension, Total (Male, Female) | |||
|---|---|---|---|---|---|
| Male | Female | Difference | Total | ||
| 15–19 | 42.0 (41.3, 42.7) | 38.8 (38.0, 39.6) | 3.2 (1.7, 4.7) *** | 40.4 (39.9, 41.0) | 32.8 (28.7, 37.0) |
| 20–24 | 37.8 (37.1, 38.5) | 34.2 (33.4, 35.0) | 3.6 (2.1, 5.0) *** | 36.0 (35.5, 36.5) | 35.1 (30.4, 39.8) |
| 25–29 | 33.6 (32.9, 34.3) | 29.7 (29.0, 30.5) | 3.9 (2.4, 5.3) *** | 31.6 (31.1, 32.1) | 37.6 (32.1, 42.9) |
| 30–34 | 29.3 (28.7, 30.0) | 25.6 (24.8, 26.3) | 3.8 (2.3, 5.2) *** | 27.4 (26.9, 27.9) | 40.4 (34.5, 46.0) |
| 35–39 | 25.3 (24.6, 26.0) | 21.8 (21.0, 22.5) | 3.5 (2.1, 5.0) *** | 23.5 (23.0, 24.) | 42.9 (36.7, 48.9) |
| 40–44 | 21.6, (21.0, 22.3) | 18.5 (17.7, 19.2) | 3.1 (1.7, 4.6) *** | 20.0 (19.5, 20.5) | 45.1 (38.8, 51.3) |
| 45–49 | 17.9 (17.3, 18.6) | 15.5 (14.8, 16.3) | 2.4 (1.1, 3.8) *** | 16.8 (16.3, 17.2) | 47.5 (41.6, 53.3) |
| 50–54 | 14.8 (14.1, 15.4) | 13.0 (12.2, 13.7) | 1.8 (0.4, 3.2) ** | 13.9 (13.5, 14.4) | 49.3 (43.9, 55.0) |
| 55–59 | 12.1 (11.5, 12.7) | 10.6 (9.9, 11.3) | 1.4 (0.1, 2.7) * | 11.4 (10.9, 11.9) | 51.3 (46.1, 56.6) |
| 60–64 | 9.6 (9.0, 10.2) | 8.5 (7.8, 9.2) | 1.1 (-0.2, 2.3) | 9.1 (8.7, 9.6) | 52.9 (48.4, 58.1) |
| 65–69 | 7.4 (6.9, 8.0) | 6.7 (6.0, 7.4) | 0.8 (-0.5, 2.0) | 7.1 (6.7, 7.6) | 54.3 (50.1, 59.3) |
| 70–74 | 5.8 (5.2, 6.3) | 5.0 (4.3, 5.6) | 0.8 (-0.4, 2.0) | 5.4 (5.0, 5.8) | 55.6 (50.8, 60.9) |
| 74–79 | 4.0 (3.5, 4.6) | 3.1 (2.5, 3.7) | 0.9 (-0.2, 2.0) | 3.6 (3.2, 4.0) | 58.5 (51.1, 65.9) |
| 80+ | 2.7 (2.2, 3.2) | 2.3 (1.7, 2.8) | 0.4 (-0.6, 1.4) | 2.5 (2.1, 2.8) | 63.5 (57.4, 68.6) |
| z ≤ 0.001=***, ≤ 0.01=**, ≤ 0.05=* | |||||
Diabetes-free life expectancy
Table 3 presents the Diabetes free life expectancy with 95 percent confidence intervals in Bangladesh. The prevalence of diabetes is lower than hypertension and much more likely to occur at a later age. The years spent without diabetes are 53.2 years, 54.5 years for females, and 52.1 years for males. The percentage of years lived with diabetes is 11.6% for both males and females.
| Age | Diabetes Free Life Expectancy (95% CI) | % of Years Lived with Diabetes, Total (Male, Female) | |||
|---|---|---|---|---|---|
| Male | Female | Difference | Total | ||
| 15–19 | 52.1 (51.6, 52.7) | 54.5 (54.0, 55.1) | -2.4 (-3.5, -1.3) *** | 53.2 (52.9, 53.6) | 11.6 (11.5, 11.5) |
| 20–24 | 47.7 (47.2, 48.3) | 50.0 (49.4, 50.6) | -2.2 (-3.3, -1.1) *** | 48.7 (48.4, 49.1) | 12.2 (12.1, 12.2) |
| 25–29 | 43.2 (42.7, 43.7) | 45.4 (44.8, 45.9) | -2.1 (-3.3, -1.1) *** | 44.1 (43.8, 44.5) | 12.9 (12.7, 13.0) |
| 30–34 | 38.6 (38.1, 39.1) | 40.8 (40.2, 41.4) | -2.2 (-3.3, -1.1) *** | 39.6 (39.2, 40.0) | 13.9 (13.8, 13.7) |
| 35–39 | 34.1 (33.6, 34.6) | 36.5 (35.9, 37.0) | -2.3 (-3.4, -1.2) *** | 35.2 (34.8, 35.6) | 14.6 (14.7, 14.4) |
| 40–44 | 29.8 (29.3, 30.3) | 32.3 (31.7, 32.8) | -2.4 (-3.5, -1.4) *** | 30.9 (30.6, 31.3) | 15.2 (15.5, 14.9) |
| 45–49 | 25.8 (25.3, 26.3) | 28.2 (27.6, 28.7) | -2.4 (-3.4, -1.3) *** | 26.9 (26.5, 27.3) | 15.6 (15.8, 15.1) |
| 50–54 | 22 (21.5, 22.5) | 24.5 (23.9, 25.0) | -2.5 (-3.5, -1.4) *** | 23.1 (22.8, 23.5) | 15.8 (16.4, 15.0) |
| 55–59 | 18.8 (18.3, 19.2) | 20.9 (20.4, 21.4) | -2.2 (-3.1, -1.2) *** | 19.8 (19.4, 20.1) | 15.6 (16.2, 14.6) |
| 60–64 | 15.5 (15.0, 15.9) | 17.4 (16.9, 17.9) | -1.9 (-2.9, -1.0) *** | 16.4 (16.0, 16.7) | 15.6 (16.8, 14.2) |
| 65–69 | 12.5 (12.1, 12.9) | 14.1 (13.6, 14.6) | -1.7 (-2.6, -0.7) *** | 13.3 (12.9, 13.6) | 15.0 (16.3, 13.8) |
| 70–74 | 9.8 (9.4, 10.3) | 11.0 (10.5, 11.4) | -1.1 (-2.0, -0.2) * | 10.4 (10.1, 10.7) | 14.9 (15.8, 13.7) |
| 74–79 | 7.0 (6.6, 7.4) | 7.9 (7.6, 8.4) | -0.9 (-1.7, -0.1) * | 7.5 (7.2, 7.8) | 14.0 (14.3, 12.8) |
| 80+ | 5.3 (4.9, 5.7) | 6.4 (6.0, 6.8) | -1.1 (-1.8, -0.3) | 5.9 (5.6, 6.2) | 13.3 (15.5, 10.9) |
| z ≤ 0.001=***, ≤ 0.01=**, ≤ 0.05=* | |||||
Either hypertension or diabetes-free life expectancy
Table 4 presents either hypertension or diabetes-free life expectancy with 95 confidence intervals (CI). Male spends 38.1 years of their life expectancy with either of the disease-free. On the other hand, the females spend 35.6 years either hypertension or diabetes-free. The percentage of life spent with either of the diseases is 38.7.
| Age | Either Hypertension or Diabetes Free Life Expectancy (95% CI) | % of Years Lived with Either H/D, Total (Male, Female) | |||
|---|---|---|---|---|---|
| Male | Female | Difference | Total | ||
| 15–19 | 38.1 (37.3, 38.9) | 35.6 (34.8, 36.4) | 2.5 (0.9, 4.1) ** | 36.9 (36.3, 37.4) | 38.7 (35.3, 42.2) |
| 20–24 | 34.1 (33.4, 34.9) | 31.2 (30.4, 32.0) | 3.0 (1.4, 4.5) *** | 32.6 (32.1, 33.2) | 41.2 (37.2, 45.2) |
| 25–29 | 30.1 (29.3, 30.8) | 26.9 (26.1, 27.7) | 3.2 (1.7, 4.8) *** | 28.4 (27.9, 28.9) | 44.0 (39.2, 48.5) |
| 30–34 | 25.9 (25.2, 26.7) | 22.9 (22.1, 23.7) | 3.1 (1.5, 4.6) *** | 24.4 (23.8, 24.9) | 47.0 (42.1, 51.6) |
| 35–39 | 22.2 (21.5, 22.9) | 19.3 (18.5, 20.1) | 2.9 (1.4, 4.4) *** | 20.7 (20.2, 21.2) | 49.7 (44.6, 54.7) |
| 40–44 | 18.7 (18.1, 19.4) | 16.3 (15.5, 17.1) | 2.4 (1.0, 3.9) ** | 17.5 (17.0, 18.1) | 52.0 (46.9, 56.9) |
| 45–49 | 15.5 (14.8, 16.2) | 13.7 (12.9, 14.4) | 1.8 (0.4, 3.3) ** | 14.6 (14.1, 15.1) | 54.2 (49.5, 58.8) |
| 50–54 | 12.6 (11.9, 13.2) | 11.4 (10.7, 12.2) | 1.1 (-0.2, 2.5) * | 12.1 (11.6, 12.6) | 56.1 (52.2, 60.4) |
| 55–59 | 10.3 (9.7, 11.0) | 9.4 (8.7, 10.1) | 1.0 (-0.4, 2.3) | 9.9 (9.5, 10.4) | 57.6 (53.8, 61.7) |
| 60–64 | 8.1 (7.6, 8.7) | 7.4 (6.7, 8.1) | 0.7 (-0.6, 2.0) | 7.9 (7.4, 8.3) | 59.4 (56.2, 63.4) |
| 65–69 | 6.4 (5.8, 6.9) | 5.9 (5.2, 6.5) | 0.5 (-0.8, 1.8) | 6.2 (5.7, 6.6) | 60.3 (57.3, 64.3) |
| 70–74 | 4.9 (4.4, 5.5) | 4.3 (3.7, 5.0) | 0.6 (-0.6, 1.8) | 4.7 (4.3, 5.1) | 61.5 (57.3, 66.0) |
| 74–79 | 3.4 (2.9, 4.0) | 2.7 (2.1, 3.3) | 0.7 (-0.4, 1.9) | 3.1 (2.7, 3.5) | 64.0 (58.4, 70.6) |
| 80+ | 2.2 (1.7, 2.7) | 1.9 (1.4, 2.4) | 0.3 (-0.7, 1.3) | 2.1 (1.7, 2.4) | 69.4 (65.0, 73.5) |
| z ≤ 0.001=***, ≤ 0.01=**, ≤ 0.05=* | |||||
Both hypertension and diabetes-free life expectancy
Table 5 presents both hypertension and diabetes-free life expectancy with a 95 percent confidence interval. On average, the population of Bangladesh spends 6% of their total life span with both diseases. The females spend more years with both hypertension and diabetes-free (57.5 years) than males (55.8 years).
| Age | Both Hypertension and Diabetes Free Life Expectancy (95% CI) | % of Years Lived with Both H/D, Total (Male, Female) | |||
|---|---|---|---|---|---|
| Male | Female | Difference | Total | ||
| 15–19 | 55.8 (55.5, 56.2) | 57.5 (57.0, 58.0) | -1.7 (-2.5, -0.8) *** | 56.6 (56.3, 56.9) | 6.0 (5.2, 6.6) |
| 20–24 | 51.2 (50.8, 51.6) | 52.8 (52.4, 53.3) | -1.6 (-2.5, -0.8) *** | 51.9 (51.6, 52.2) | 6.4 (5.7, 7.1) |
| 25–29 | 46.5 (46.1, 46.9) | 48.0 (47.6, 48.5) | -1.5 (-2.4, -0.7) *** | 47.2 (46.9, 47.5) | 6.9 (6.1, 7.8) |
| 30–34 | 41.8 (41.4, 42.2) | 43.3 (42.8, 43.8) | -1.5 (-2.4, -0.7) *** | 42.4 (42.1, 42.7) | 7.7 (6.8, 8.5) |
| 35–39 | 37.0 (36.6, 37.4) | 38.7 (38.2, 39.2) | -1.7 (-2.6, -0.8) *** | 37.8 (37.5, 38.1) | 8.3 (7.4, 9.1) |
| 40–44 | 32.5 (32.1, 32.8) | 34.2 (33.7, 34.7) | -1.7 (-2.6, -0.9) *** | 33.2 (32.9, 33.5) | 8.9 (8.1, 9.8) |
| 45–49 | 28.1 (27.7, 28.4) | 29.8 (29.3, 30.3) | -1.7 (-2.6, -0.9) *** | 28.9 (28.6, 29.2) | 9.5 (8.6, 10.3) |
| 50–54 | 24.0 (23.6, 24.4) | 25.8 (25.3, 26.3) | -1.8 (2.6, -1.0) *** | 24.8 (24.5, 25.1) | 9.7 (8.7, 10.4) |
| 55–59 | 20.3 (19.9, 20.7) | 22.0 (21.6, 22.5) | -1.7 (-2.5, -0.9) *** | 21.1 (20.8, 21.4) | 9.9 (9.4, 10.2) |
| 60–64 | 16.8 (16.4, 17.1) | 18.3 (17.8, 18.7) | -1.5 (-2.3, -0.7) *** | 17.5 (17.2, 17.8) | 9.9 (9.9, 9.9) |
| 65–69 | 13.4 (13.0, 13.7) | 14.8 (14.4, 15.3) | -1.5 (-2.2, -0.7) *** | 14.1 (13.8, 14.4) | 9.7 (10.1, 9.5) |
| 70–74 | 10.6 (10.3, 10.9) | 11.5 (11.1, 11.9) | -0.9 (-1.6, -0.2) * | 11.1 (10.8, 11.3) | 9.3 (9.2, 9.3) |
| 74–79 | 7.5 (7.2, 7.8) | 8.2 (7.8, 8.6) | -0.7 (-1.4, 0.0) * | 7.9 (7.7, 8.1) | 9.2 (8.2, 9.5) |
| 80+ | 5.7 (5.4, 6.0) | 6.7 (6.3, 7.0) | -0.9 (-1.6, -0.3) ** | 6.2 (6.0, 6.4) | 8.5 (9.2, 7.5) |
| z ≤ 0.001=***, ≤ 0.01=**, ≤ 0.05=* | |||||
The study aimed to explore the contribution of hypertension and diabetes to healthy life expectancy reduction in Bangladesh. The prevalence of hypertension and diabetes is relatively high in Bangladesh. On average, a person aged 15–19 is expected to live 32.8% of their life with hypertension in Bangladesh. Whereas the life expectancy of those ages 15–19 was 58.9 years in 2018 in Bangladesh, they would spend 40.4 years without hypertension. Almost 18.5 years are expected to live with hypertension. These findings correlate with other study findings 8,19. The main reason for this high prevalence of hypertension in Bangladesh is the increasing prevalence of obesity, tobacco use, high intake of processed foods, salt intake, and less physical activity 8,19.
Males spend more years hypertension free than females. Several studies found the reason for females' higher prevalence of hypertension, including higher prevalence of obesity, use of oral contraception, preeclampsia and menopause, gender difference in functional status, nutritional status, inadequate health care service availability for women, patriarchy, and culture. Women are outliving men in Bangladesh, which also works as a reason for women's more years living with hypertension 12.
On the contrary, the prevalence of diabetes is less acute than hypertension. The number of years spends without diabetes is 53.2 years. Males and females have different patterns in diabetes when compared to hypertension. Females spend more years without diabetes. The main reason is compiled of biological and lifestyle-related reasons. A higher prevalence of type 2 diabetes in men than in women is associated with differences in Visceral Fat Mass as males store more fat in their bellies. In different studies, physical activity, smoking, and indifference to test the disease are shown as reasons 20,21.
Furthermore, either hypertension or diabetes-free life expectancy presents the burden of both diseases on the population. Again, females spend fewer years (35.6 years) without either disease than 38.1 years for males. Around 39% of life is spent with either disease in Bangladesh, whereas 6% with both diseases. Females spend more years with both diseases. This pattern is also evident in other literature, indicating the life expectancy advantages of women in Bangladesh as Failures of success. Increasing life expectancy comes with chronic disease, economic insolvency, poor mental health, and misery. The lifelong discrimination and patriarchy are becoming evident with disease patterns 22.
Both diabetes and hypertension are more prevalent with increasing age. The percentage of years lived with both hypertension and diabetes is increasing with age. This finding is also consistent with another study, as the prevalence of communicable diseases increases with age 6,8,13,19.
This study has some important strengths. This study has discovered the effects of both diseases on life expectancy and healthy life expectancy in Bangladesh. It is crucial to increase the burden of non-communicable diseases for the population with increasing life expectancy. The Sullivan method for calculating healthy life expectancy has some important strengths. It is straightforward to apply to data from cross-sectional studies and less influenced by survey design and analytic strategies than methods relying on longitudinal data.
The limitations of the methods include the method's assumptions constraining the portrayal of the expected life cycle or functional status histories of persons exposed to current mortality and morbidity conditions. It does not permit recovery once individuals have experienced a health problem. It will yield an inaccurate portrayal of the timing and volume of a cohort's health experiences under conditions in which individuals experience the onset of health problems and recovery. Although the Sullivan method could not detect a sudden change in health problems, it provides relatively stable estimates as the multistate life table method if there are smooth and relatively regular changes in health problems prevalence rates over a long time 23,24.
The world is experiencing increasing life expectancy due to improved socioeconomic conditions and medical and public health advancements. Bangladesh is no exception to it. With increasing life expectancy, non-communicable diseases and their impact on later life have become more significant than ever. This study provides insights into diabetes and hypertension-free life expectancy in Bangladesh. Diabetes and hypertension are becoming more prevalent day by day in the country. These two diseases directly affect mortality and morbidity, and it also works as contributing factor to other diseases. In these circumstances, policies and programs need to reduce the prevalence of diabetes and hypertension. Efforts must be made from the early stages of life through physical activity, food patterns, salt taking, mental health, and other factors. Mass screening programs need to be enforced to detect taking steps early and appropriately. The focus should be given cost-effective and readily available treatment for both diseases. Women suffer more from both diseases. Particular focus should be given to women as they live more than males. This study has brought forward this quality-of-life dimension with the quantity dimension of life expectancy. This study will work to ignite consciousness among policymakers and people about the burden of diabetes and hypertension.
Data availability statement
The 2017–18 BDHS data set is anonymized and freely available at https://dhsprogram.com/data/, and the instructions were followed for using the data. The published Bangladesh sample vital statistics of 2018 is available at the Bangladesh Bureau of Statistics (BBS) website: http://www.bbs.gov.bd/site/page/ef4d6756-2685-485a-b707-aa2d96bd4c6c/-.
Ethics approval and consent to participate
The National Institute of Population Research and Training (NIPORT) of the Ministry of Health and Family Welfare conducted the 2017–18 BDHS. The survey was implemented by a Bangladeshi firm named Mitra and Associates of Bangladesh, while the ICF International of USA provided technical assistance as part of its international Demographic and Health Surveys Program. If the respondent provided their verbal consent in response to being read out an informed consent statement by the interviewer, only then was an interview conducted. The ethical approval for the survey was taken by the NIPORT from the Bangladesh Medical Research Council (BMRC).
Consent to publication
Not applicable.
Competing interests
The author declares that they have no competing interests.
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No competing interests reported.