title: Prevalence and determinants of hypertension in Myanmar - a nationwide cross-sectional study.
abstract: Non-communicable diseases (NCDs), malaria and tuberculosis dominate the disease pattern in Myanmar. Due to urbanization, westernized lifestyle and economic development, it is likely that NCDs such as cerebrovascular disease and ischemic heart disease are on a rise. The leading behavioral- and metabolic NCDs risk factors are tobacco smoke, dietary risks and alcohol use, and high blood pressure and body mass index, respectively. The study aimed at estimating the prevalence and determinants of hypertension, including metabolic-, behavioral- and socio-demographic risk factors.
  
  
  
  A nationwide, cross-sectional study of 7429 citizens of Myanmar aged 15-64 years were examined in 2009, using the WHO STEPS methodology. In separate analyses by gender, odds radios (ORs) and 95 % confidence intervals (CIs) for determinants of hypertension were estimated using logistic regression analyses. Confounders included in analyses were chosen based on Directed acyclic graphs (DAGs).
  
  
  
  The prevalence of hypertension was 30.1 % (95 % CI: 28.4-31.8) in males and 29.8 % (28.5-31.1) in females. The mean BMI was 21.7 (SD 4.3) kg/m(2) for males and 23.0 (5.1) kg/m(2) for females. In fully adjusted analyses, we found in both genders increased OR for hypertension if the participants had high BMI (males: OR = 2.6; 95 % CI 2.1-3.3, females: OR = 2.3; 2.0-2.7) and high waist circumference (males: OR = 3.4; 1.8-6.8, females: OR = 2.7; 2.2-3.3). In both sexes, associations were also found between hypertension and low physical activity at work, or living in urban areas or the delta region. Being underweight and use of sesame oil in cooking was associated with lower odds for hypertension.
  
  
  
  The prevalence of hypertension was high and associated with metabolic-, behavioral- and socio-demographic factors. Due to expected rapid economic growth in Myanmar we recommend similar studies in the future to follow up and describe trends in the risk factors, especially modifiable factors, which will most likely be on rise. Studies on effectiveness on interventions are needed, and policies to reduce the burden of NCD risk factors should be implemented if proven effective in similar settings.
authors.affiliation: Section for Preventive Medicine and Epidemiology, Department of Community Medicine, University of Oslo, Oslo, Norway. m.b.bjertness@studmed.uio.no.
authors.forename: Marius B
authors.initials: MB
authors.lastname: Bjertness
authors.affiliation: Section for Preventive Medicine and Epidemiology, Department of Community Medicine, University of Oslo, Oslo, Norway.|International Health Department, Ministry of Health, Nay Pyi Taw, Myanmar.
authors.forename: Aung Soe
authors.initials: AS
authors.lastname: Htet
authors.affiliation: Section for Preventive Medicine and Epidemiology, Department of Community Medicine, University of Oslo, Oslo, Norway.|Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Haakon E
authors.initials: HE
authors.lastname: Meyer
authors.affiliation: International Health Department, Ministry of Health, Nay Pyi Taw, Myanmar.
authors.forename: Maung Maung Than
authors.initials: MM
authors.lastname: Htike
authors.affiliation: Department of Medical Research, Ministry of Health, Nay Pyi Taw, Myanmar.
authors.forename: Ko Ko
authors.initials: KK
authors.lastname: Zaw
authors.affiliation: Department of Preventive and Social Medicine, University of Medicine 1, Yangon, Myanmar.
authors.forename: Win Myint
authors.initials: WM
authors.lastname: Oo
authors.affiliation: University of Medicine 2, Yangon, Myanmar.
authors.forename: Tint Swe
authors.initials: TS
authors.lastname: Latt
authors.affiliation: Section for Preventive Medicine and Epidemiology, Department of Community Medicine, University of Oslo, Oslo, Norway.
authors.forename: Lhamo Y
authors.initials: LY
authors.lastname: Sherpa
authors.affiliation: Section for Preventive Medicine and Epidemiology, Department of Community Medicine, University of Oslo, Oslo, Norway.
authors.forename: Espen
authors.initials: E
authors.lastname: Bjertness
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000453:epidemiology*; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D002052:Myanmar / Q000453:epidemiology; D009765:Obesity / Q000150:complications*; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D055105:Waist Circumference; D055815:Young Adult
keywords: Alcohol; Body-mass index; Hypertension; Myanmar; NCD risk factors; Nationwide; Smoking; Waist circumference