No. 3, July 2008
Self-Reported Prevalence of Chronic Diseases and Their Relation to Selected Sociodemographic Variables: A Study in INDEPTH
Asian Sites, 2005
Hoang Van Minh, MD, PhD, Nawi Ng, MD, PhD, Sanjay Juvekar, PhD, Abdur Razzaque, MD, PhD, Ali Ashraf, MPH, Abdullahel Hadi, MD, PhD, Kusol Soonthornthada, Tran Huu
Bich, MD, PhD, Uraiwan Kanungsukkasem, Peter Byass, PhD
Suggested citation for this article: Minh HV, Ng N, Juvekar S, Razzaque A, Ashraf A, Hadi A, et al. Self-reported prevalence of chronic diseases and their relation to selected sociodemographic variables: a study in INDEPTH Asian sites, 2005. Prev Chronic Dis 2008;5(3).
jul/07_0115.htm. Accessed [date].
Lack of reliable population-based data, especially morbidity data, is a barrier to preventing and controlling chronic diseases in developing countries. We report the self-reported prevalences of major chronic diseases
in Southeast Asia and examine their relation to selected sociodemographic variables in adults.
Data are from a 2005 cross-site study of 8 sites in 5 Asian countries that surveyed 18,484 people aged 25–64 years. Respondents were asked whether they had
been told by a health care worker that they had any of 7 chronic health conditions: joint problems, stroke, heart disease, diabetes, pulmonary disease, hypertension, or cancer. Information
about participants’ sex, age, and educational level was also obtained.
We found that 22.7% of men and 31.6% of women reported having at least 1 of the chronic
health conditions of interest, and 5.1% of men and 9.2% of women reported having
2 or more chronic conditions. Multivariate regression analyses showed that women had more chronic
conditions than men, the prevalence of chronic conditions increased with age, and people with the least education were more likely to have chronic
Chronic conditions are commonly reported among adults in Asian countries. Disparities in the prevalence of chronic
conditions by sex and education are evident.
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Chronic diseases are leading causes of morbidity and mortality worldwide (1-5). In 2005, of 58 million all-cause deaths worldwide, 35 million were attributable to chronic diseases, and 80% of those were in developing countries (3). Chronic diseases kill more middle-aged people in poorer
than in wealthier countries, and chronic diseases affect 5 times as many people as
human immunodeficiency virus/AIDS does in developing nations (3). Because health care systems in
developing countries usually are designed to manage acute communicable diseases, the increasing prevalence of chronic disease is a major challenge (3,5-9).
Mortality from chronic diseases is also increasing in Asia (10,11); however, lack of reliable population-based data, especially morbidity data, is a
barrier to preventing and controlling chronic diseases in these countries. Thus far, little attention has
been paid to the problem, particularly with regard to conducting surveillance to monitor trends over time and across populations (3,12).
To provide information about epidemiologic aspects of chronic diseases in Asian countries, we report the self-reported prevalence of major chronic
conditions and examine their relation to selected sociodemographic factors among adults from
8 demographic surveillance system (DSS) sites in 5 Asian countries.
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INDEPTH (International Network for Demographic Evaluation of Populations and Their Health) (www.indepth-network.org) is an international network of DSS sites founded to link existing demographic field sites. The objectives of INDEPTH are to 1) initiate cross-site, longitudinal health and social studies in severely resource-constrained populations; 2) disseminate findings among external stakeholders to maximize
impact on policy and practice; 3) foster and support capacity building and cross-site collaborations among INDEPTH member sites;
and 4) facilitate the process for donors to fund health and social research projects in the developing world, especially in Africa and Asia (13). Each DSS site continually measures demographic and health variables among the population of a geographically defined area (13,14).
In 2005, we conducted a cross-site study in 8 DSS sites in 5 Asian countries: FilaBavi and Chililab in Vietnam; Health System and Infectious Disease (HSID), Woman Abuse Tracking in Clinics and Hospitals (WATCH), and Matlab in
Bangladesh; Kanchanaburi in Thailand; Purworejo in Indonesia; and Vadu
in India. A representative sample of approximately 1000 men and 1000 women aged 25
to 64 years was randomly selected
from existing DSS sampling frames and surveyed at each
site, except at HSID, where the sample was approximately 2000 men and 2000 women.
The total surveyed was 18,484. Data were collected through personal household interviews conducted
by trained field workers. A standardized structured questionnaire was used at all sites to collect information
about chronic conditions and sociodemographic variables. Field supervisors and the investigators of this study
controlled data quality in the field.
Self-reported chronic conditions
Respondents were asked if they had ever been told by a health care worker that they had any of
7 chronic health conditions: joint problems, stroke, heart disease, diabetes, pulmonary disease, hypertension, or cancer. Other conditions, such as kidney disease, skin disease, or psychological disorders, were not included
because the prevalence of those diseases in the study population is low. We
calculated the total number of chronic conditions by adding the number of positive
responses to these questions.
Sex, age, and educational level were recorded for each participant. Education was used as a proxy for socioeconomic status, which has several advantages in our settings. Education tends to determine occupation and is usually stable after young adulthood. Unlike occupational class, education allows classification of persons who do not work. Educational status is an individual measure of socioeconomic position and may
a better indicator than those based on household measures, such as household income,
which are difficult to measure at our sites. In addition, classification of educational status,
based on the highest level of schooling, was comparable between countries. We categorized educational level into
fewer than 6 years of education, graduate of primary school (completion of grade 6), graduate of secondary school (completion of grade 9), and tertiary education (completion of grade 12) and higher.
We calculated descriptive and analytical statistics with Stata 8 (StataCorp LP, College Station, Texas). Prevalences of different chronic
conditions were calculated for each site and for all sites combined. Multivariate logistic regression and linear regression modeling
were performed to examine the probability of
developing chronic conditions in relation to sociodemographic variables at all sites. To account for different sampling methods
we introduced sampling weights on
calculations and regression analyses. Results were considered significant at P < .05.
The study protocol was approved by the scientific board of the INDEPTH network and was in accordance with the ethics codes of each site. Informed consent was obtained from all participants
before data were collected, and participants had the right to withdraw from the study at any time.
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We surveyed 9241 men and 9253 women (Table 1). At all sites and for
both sexes, the 55-
to 64-year age group had the smallest proportion of respondents. Educational level varied greatly
between sites; respondents in Bangladesh had the least education, and those in Vietnam had the most. Women were less educated at all sites, especially at the
Bangladeshi sites and
at Vadu in India.
Chronic conditions were commonly reported among respondents, especially among women
(Table 2). Joint problems and hypertension were most commonly reported, whereas stroke and cancer were
least common. The prevalence of chronic
conditions varied considerably across sites: the proportion of people with at least
condition was highest in Matlab (Bangladesh) and lowest in Purworejo (Indonesia). Approximately 5% of men and 9% of women
reported having 2 or more chronic conditions (Table 3). The proportion of people with
2 or more self-reported chronic conditions was also highest in Matlab and lowest in Purworejo.
Multivariate logistic regression analyses of the effects of sociodemographic variables on chronic
conditions showed that the prevalence of self-reported chronic conditions increased with age and
differed significantly for all reported conditions (Table 4).
However, the difference in prevalence of cancer was significant
only among people aged 55 to 64 compared with those aged 25 to 34. People with the lowest educational levels were more likely to report
condition than were those
with higher education.
The effects of sociodemographic variables on total of number of chronic
conditions were examined by multivariate linear regression
(Table 5). Women, older people, and respondents with less education were more likely to have more chronic
conditions, although the difference in the number of conditions by education was significant
only for those who graduated from primary school compared with those with fewer than 6 years of schooling.
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This study provides the first overview of the magnitude of self-reported
chronic conditions at 8 INDEPTH Asian sites. The overall self-reported prevalence of these
conditions (22.7% in men and 31.6% in women) indicates that they already affect a large proportion of the population in the study sites.
These figures are lower than the overall prevalence of 38% found in China (15), 43% in Japan (16), and 77% in the United States (17).
Women at our sites reported more chronic conditions than did men. Although men and women may perceive, evaluate, and act on symptoms differently (18), many studies have shown no differences
by sex in the reporting of chronic conditions (19,20). Our study probably indicates health disparities
by sex in Asian countries, which
suggests the need for more attention to women’s health and health care in these countries. We also found that increasing age is associated with higher self-reported
prevalence of chronic conditions, which is in concordance with other findings (8,21-23). The self-reported prevalence of chronic
conditions in our study was significantly higher among respondents with less education, even after adjusting for age and sex;
this finding is similar to those of other studies that showed inverse socioeconomic gradients in chronic diseases (16,22-24).
Some methodologic limitations of this study may affect interpretation of the results. The self-reported prevalence of chronic
conditions is subject to recall bias and may not reflect the true prevalence; reporting
also can be affected by respondents’ knowledge, manifestations of the illness in everyday life, their willingness to report
the condition, and frequency of contact with a physician (23). However, self-reports of several chronic
conditions are substantially accurate when compared with physician diagnoses (25-27). Other factors that may contribute to the differences we observed are response rates, differences in age, and variability in definitions of chronic
conditions. An additional limitation is that this cross-site study was not
designed primarily to assess social patterns of chronic conditions at each respective site; therefore, comparing disease inequalities
between sites and countries is problematic. This study,
however, provides a broad overview of general patterns throughout all sites.
Given our findings, actions to reduce levels of chronic diseases in the studied settings are needed. Interventions should focus on disadvantaged groups, especially women and people with lower education. Knowledge of the prevalence and social patterning of chronic diseases is likely to
be useful for health professionals in predicting health trends and directing health planning and interventions. Further study, as part of the ongoing INDEPTH surveillance, will help provide high-quality and
timely data to increase the effectiveness of interventions and reduce the burden of chronic disease in Southeast Asia.
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We thank the INDEPTH network for providing financial support for this study. We also thank Dr Ruth
Bonita, the World Health Organization, and Dr Anand Krishnana and his team from the
Ballabgarh DSS site in India for training support. We are also grateful to Edward Fottrell from the London School of Hygiene and Tropical Medicine for his careful editing of this article.
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Corresponding Author: Hoang Van Minh, FilaBavi Demographic Surveillance Site, 1 Ton That Tung Ha Noi, Hanoi 844, Vietnam. Telephone: 844-8523798. E-mail: email@example.com.
Author Affiliations: Nawi Ng, Purworejo Demographic Surveillance Site, Indonesia; Sanjay Juvekar, Vadu Demographic Surveillance Site, India; Abdur Razzaque, Matlab Demographic Surveillance Site,
Bangladesh; Ali Ashraf, HSID Demographic Surveillance Site, Bangladesh; Abdullahel Hadi,
WATCH Demographic Surveillance Site, Bangladesh; Kusol Soonthornthada, Uraiwan Kanungsukkasem, Kanchanaburi Demographic Surveillance Site, Thailand; Tran Huu
Bich, Chililab Demographic Surveillance Site, Vietnam;
Peter Byass, Umeå International School of Public Health, Umeå University, Umeå, Sweden.
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- Omran AR.
The epidemiologic transition. A theory of the epidemiology of population
change. Milbank Mem Fund Q 1971;49(4):509-38.
- Omran AR. The epidemiologic transition theory revisited thirty years later. World Health Stat Q 1998;51:99-119.
- Preventing chronic diseases — a vital investment. Geneva (CH): World Health Organization; 2005.
- Yusuf S, Reddy S, Ounpuu S, Anand S.
burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation 2001;104(22):2746-53.
- Leeder S, Raymond S, Greenberg H, Liu H, Esson K. A race against time: the challenge of cardiovascular disease in developing economies. New York
(NY): The Center for Global Health and Economic Development; 2004.
- Strong K, Mathers C, Leeder S, Beaglehole R.
Preventing chronic diseases: how many lives can we save? Lancet 2005;366(9496):1578-82.
- Beaglehole R.
Global cardiovascular disease prevention: time to get serious. Lancet 2001;358(9282):661-3.
- Yach D, Kellogg M, Voute J.
Chronic diseases: an increasing challenge in developing countries. Trans R Soc Trop Med Hyg 2005;99(5):321-4.
- Yach D, Leeder SR, Bell J, Kistnasamy B.
Global chronic diseases. Science 2005;307(5708):317.
- Fifty years of the WHO in the Western Pacific Region. Report of the Regional Director to the Regional Committee for the Western Pacific Region. Manila
(PH): World Health Organization; 1998.
- Murray CJ, Lopez AD.
Global mortality, disability and contribution of risk factors: Global
Burden of Disease Study. Lancet 1997;349(9603):1436-42.
- Beaglehole R, Bonita R.
Challenges for public health in the global context — prevention and surveillance. Scand J Public Health 2001;29(2):81-3.
- INDEPTH Network: population and health in developing countries. Ottawa
(ON): INDEPTH Network, IDRC; 2002.
- Baiden F, Hodgson A, Binka F.
Demographic surveillance sites and emerging challenges in international
health. Bull World Health Organ 2006;84(3):163.
- Lam CL, Lauder IJ, Lam TP. Impact of chronic diseases on health services and quality of life of a Chinese population. Asia Pacific Family Medicine 2003;2:98-106.
- Fukuhara S, Ware JE Jr, Kosinski M, Wada S, Gandek B.
Psychometric and clinical tests of validity of the Japanese SF-36 Health Survey. J Clin Epidemiol 1998;51(11):1045-53.
- Ko Y, Coons SJ.
An examination of self-reported chronic conditions and health status in the 2001 Medicare Health Outcomes Survey. Curr Med Res Opin 2005;21(11):1801-8.
- Fernandez E, Schiaffino A, Rajmil L, Badia X, Segura A.
Gender inequalities in health and health care services use in Catalonia (Spain). J Epidemiol Community Health 1999;53(4):218-22.
- Macintyre S, Ford G, Hunt K.
“over-report” morbidity? Men’s and women’s responses to structured prompting on a standard question on long standing illness. Soc Sci Med 1999;48(1):89-98.
- Giang KB, Allebeck P.
Self-reported illness and use of health services in a rural district of Vietnam: findings from an epidemiological field laboratory. Scand J Public Health Suppl 2003;62:52-8.
- Verbrugge LM, Patrick DL.
Seven chronic conditions: their impact on US adults’ activity levels and use of medical services. Am J Public Health 1995;85(2):173-82.
- Glover JD, Hetzel DM, Tennant SK.
The socioeconomic gradient and chronic illness and associated risk factors in Australia. Aust New Zealand Health Policy 2004;1(1):8.
- Dalstra JA, Kunst AE, Borrell C, Breeze E, Cambois E, Costa G, et al.
Socioeconomic differences in the prevalence of common chronic diseases: an overview of eight European countries. Int J Epidemiol 2005;34(2):316-26.
- Yeo M, Sawyer S.
Chronic illness and disability.
- Kriegsman DM, Penninx BW, Van Eijk JT, Boeke AJ, Deeg DJ.
Self-reports and general practitioner information on the presence of chronic diseases in community dwelling elderly. A study on the accuracy of patients’ self-reports and on determinants of inaccuracy. J Clin Epidemiol 1996;49(12):1407-17.
- Goldman N, Lin IF, Weinstein M, Lin YH.
Evaluating the quality of self-reports of hypertension and diabetes. J Clin Epidemiol 2003;56(2):148-54.
- Kehoe R, Wu SY, Leske MC, Chylack LT Jr.
Comparing self-reported and physician-reported medical history. Am J Epidemiol 1994;139(8):813-8.
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