Health risk factors and the incidence of hypertension: 4-year prospective findings from a national cohort of 60 569 Thai Open University students

Abstract

ObjectiveThis study evaluates the impact of a number of demographic, biological, behavioural and lifestyle health risk factors on the incidence of hypertension in Thailand over a 4-year period.DesignA 4-year prospective study of health risk factors and their effects on the incidence of hypertension in a national Thai Cohort Study from 2005 to 2009.SettingAs Thailand is transitioning from a developing to a middle-income developed country, chronic diseases (particularly cardiovascular disease) have emerged as major health issues. Hypertension is a major risk factor for heart attack and stroke and cross-sectional studies have indicated that the prevalence is increasing.Study participantsA total of 57 558 Sukhothai Thammathirat Open University students who participated in both the 2005 and 2009 questionnaire surveys and who were normotensive in 2005 were included in the analysis.MeasuresAdjusted relative risks associating each risk factor and incidence of hypertension by sex, after controlling for confounders such as age, socioeconomic status, body mass index (BMI) and underlying diseases.ResultsThe overall 4-year incidence of hypertension was 3.5%, with the rate in men being remarkably higher than that in women (5.2% vs 2.1%). In both sexes, hypertension was associated with age, higher BMI and comorbidities but not with income and education. In men, hypertension was associated with physical inactivity, smoking, alcohol and fast food intake. In women, hypertension was related to having a partner.ConclusionsIn both men and women, hypertension was strongly associated with age, obesity and comorbidities while it had no association with socioeconomic factors. The cohort patterns of socioeconomy and hypertension reflect that the health risk transition in Thais is likely to be at the middle stage. Diet and lifestyle factors associate with incidence of hypertension in Thais and may be amenable targets for hypertension control programmes.

Health-Risk Transition and 8-Year Hypertension Incidence in a Nationwide Thai Cohort Study

“…Although the trend of cigarette smoking in Thai men is declining its prevalence still exceeds 20% overall and reaches 40% in some groups (Kamsa-ard, 2013;Zhao, Pachanee, et al, 2015). Regular smoking is directly associated with a higher incidence of hypertension (Thawornchaisit et al, 2013c). The traditional expectation that females do not smoke continues to powerfully protect half of the population from tobacco related illness, including hypertension.…”

“…The study participants live all over Thailand and represent people well socio-demographically (Seubsman et al, 2012) even though they are younger and have a higher education attainment than average for general population. A previous 4-year follow up study in 2009 (Thawornchaisit et al, 2013c) and associated 2005 baseline cross-sectional study (Thawornchaisit et al, 2013a) identified risk factors for hypertension in Thai people. But the results of this 8-year study will be more accurate despite losing some statistical power due to cohort attrition.…”

“…At baseline in 2005, the mostly young cohort had an overall prevalence of hypertension of 4.6% (Thawornchaisit et al, 2013a). Over the 4-year follow up from 2005 to 2009 the cumulative incidence of hypertension was 3.5% (Thawornchaisit et al, 2013c). Now we have measured the 8-year incidence of hypertension and its associations and effects and we are able to report on a larger time sample of the cohort transitions that are operating to produce CVD in Thailand.…”

“…There are few studies reporting directly measured incidence of hypertension in Thailand (Thawornchaisit et al, 2013c;Vathesatogkit et al, 2012). Our Thai Cohort Study (TCS), ongoing since 2005, is focused on the transition in health risks accompanying modernization.…”

Studying the Thai Health‑Risk Transition

“…more one-person or couple-with-no-children households). Health and other social outcomes of urbanisers were closer to those in the urban-urban group and were worse than the rural-rural group, with lower self-assessed health and a higher prevalence of hypertension, depression and obesity Seubsman et al, 2010Seubsman et al, , 2011Thawornchaisit et al, 2013).…”