Global prevalence and trends in hypertension and type 2 diabetes mellitus among slum residents: a systematic review and meta-analysis

Abstract

ObjectiveFirst, to obtain regional estimates of prevalence of hypertension and type 2 diabetes in urban slums; and second, to compare these with those in urban and rural areas.DesignSystematic review and meta-analysis.Eligibility criteriaStudies that reported hypertension prevalence using the definition of blood pressure ≥140/90 mm Hg and/or prevalence of type 2 diabetes.Information sourcesOvid MEDLINE, Cochrane CENTRAL and EMBASE from inception to December 2020.Risk of biasTwo authors extracted relevant data and assessed risk of bias independently using the Strengthening the Reporting of Observational Studies in Epidemiology guideline.Synthesis of resultsWe used random-effects meta-analyses to pool prevalence estimates. We examined time trends in the prevalence estimates using meta-regression regression models with the prevalence estimates as the outcome variable and the calendar year of the publication as the predictor.ResultsA total of 62 studies involving 108 110 participants met the inclusion criteria. Prevalence of hypertension and type 2 diabetes in slum populations ranged from 4.2% to 52.5% and 0.9% to 25.0%, respectively. In six studies presenting comparator data, all from the Indian subcontinent, slum residents were 35% more likely to be hypertensive than those living in comparator rural areas and 30% less likely to be hypertensive than those from comparator non-slum urban areas.Limitations of evidenceOf the included studies, only few studies from India compared the slum prevalence estimates with those living in non-slum urban and rural areas; this limits the generalisability of the finding.InterpretationThe burden of hypertension and type 2 diabetes varied widely between countries and regions and, to some degree, also within countries.PROSPERO registration numberCRD42017077381.

Evidence Review: COVID-19 Recovery in South Asian Urban Informal Settlements

“…hypertensive or have Type 2 Diabetes compared to rural counterparts. 38 However, the burden of hypertension, cancer, and diabetes is estimated to be less compared to non-informal settlement urban residents. 38 Mental health.…”

“…38 However, the burden of hypertension, cancer, and diabetes is estimated to be less compared to non-informal settlement urban residents. 38 Mental health. While mental health is an important part of health and well-being, it is often ignored in informal settlements.…”

Spatial patterns in sociodemographic factors explain to a large extent the prevalence of hypertension and diabetes in Aragon (Spain)

“…When specifically addressing multi-morbidity, the sociodemographic structure has been highlighted as a key determinant, identifying the elderly, female, and socioeconomically deprived people as those particularly vulnerable to chronic conditions and multi-morbidity (9)(10)(11)(12). These conditions, along with individual lifestyles and metabolic risk factors, often promote (among other conditions) hypertension and type-2 diabetes mellitus (13). These two NCDs are currently in the spotlight due to their increasing burden worldwide −422 and 1,278 million for diabetes and hypertension in 2014 and 2019, respectively (14,15), as one of the most frequent modes of multi-morbidity (16,17) fostered by their considerable overlap in terms of risk factors (18, 19).…”

“…There is a large body of literature devoted to multi-morbidity following a variety of approaches. For example, Johnston et al ( 20 ) addressed the definition and measurement of multi-morbidity; Prados-Torres et al ( 21 ) and Rajoo et al ( 22 ) identified the most common patterns of disease association; Violán et al ( 23 ) highlighted the importance of socioeconomic status as an aggravating factor in multi-morbidity; and Uthman et al ( 13 ) explored the levels of vulnerability between urban and rural settings. However, the afore mentioned studies were conducted at the individual level, largely disregarding the social environment.…”

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“…The increasing trend and high burden of hypertension in LMICs is worrisome particularly because most of the limited resources for healthcare spending is allocated to managing infectious disease burden in these countries. The burden of hypertension among slum populations specifically is high and rising [9]. Barriers to blood pressure control exist at various levels.…”