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      Prevalence and risk factors of hypertension among Hui population in China : A systematic review and meta-analysis based on 30,565 study participants

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          Abstract

          Background:

          Hypertension (HTN) has been considered as a health concern in developing countries. And Hui is a minority group with a large population in China. Its genetic background, inadequate access to health services, eating habits, religious belief, ethnic customs, and other factors differ from that of other ethnic groups, which may influence the prevalence of HTN. However, there is no current meta-analysis on the prevalence and risk factors of HTN among Hui population. Thus we conducted a systematic review aiming to estimate the pooled prevalence and risk factors of HTN among Hui population.

          Methods:

          PubMed, The Cochrane library, Web of science, CINAHL Complete, Weipu Database (VIP), China Knowledge Resource Integrated Database (CNKI), Wanfang Database, and SinoMed were systematically searched from inception to February 28, 2020 with publication language restricted to English and Chinese. We included cross-sectional, case–control, or cohort studies that focused on prevalence and risk factors of HTN among Hui population. Two investigators independently assessed the risk of bias of the studies included in the review using tools developed by JBI. Meta-analysis was conducted using Stata 12.0 software package.

          Results:

          Twenty-three studies were identified with a total of 30,565 study participants. The overall pooled prevalence of HTN was 28% (95% confidence interval [CI]: 24%–32%, I 2 = 98.8%, P < .001). Stratified by gender, the pooled prevalence of HTN in Hui was 26% (95%CI: 20%–33%, I 2 = 97.6%, P < .001) for males and 30% (95%CI: 23%–37%, I 2 = 98.3%, P < .001) for females. Pooled prevalence of HTN in Hui was 2% (95%CI: 2%–6%, I 2  = 70.6%, P = .065), 10% (95%CI: 3%–17%, I 2 = 83.7%, P < .001), 22% (95%CI: 12%–32%, I 2 = 87.9%, P < .001), 37% (95%CI: 20%–53%, I 2 = 94.0%, P < .001), 39% (95%CI: 24%–54%, I 2 = 97.7%, P < .001) and 42% (95%CI: 29%–56%, I 2 = 95.6%, P < .001) for those aged 18 to 29, 30 to 39, 40 to 49, 50 to 59, 60 to 69, and ≥70 years, respectively. Pooled prevalence of HTN in Hui was 22% (95%CI: 14%–29%, I 2 = 97.9%, P < .001) in urban areas and 23% (95%CI: 16%–30%, I 2 = 95.8%, P < .001) in rural areas. Daily salt intake (odd ratio [OR] = 3.94, 95%CI: 3.03–5.13, I 2 = 90.2%, P < 001), family history (OR = 3.50, 95%CI: 2.60–4.71, I 2 = 95.3%, P < .001), smoking (OR = 1.84, 95%CI: 1.61–2.09, I 2 = 59.6%, P < .001), drinking (OR = 1.74, 95%CI: 1.26–2.39, I 2 = 95.3%, P = .001), weekly meat intake (OR = 1.92, 95%CI: 1.04–3.54, I 2 = 96.5%, P = .036), body mass index (OR = 2.20, 95%CI: 1.81–2.66, I 2 = 91.3%, P < .001), and areas (OR = 1.29, 95%CI: 1.10–1.51, I 2 = 81.5%, P = .001) were risk factors of HTN in Hui, while physical exercise (OR = 0.76, 95%CI: 0.66–0.88, I 2 = 62.7%, P < .001) was protective factor.

          Conclusions:

          The pooled prevalence of HTN among Hui people was 28%, daily salt intake, family history, drinking, smoking, weekly meat intake, body mass index, areas, and physical exercise were all risk factors for HTN among Hui population. Early screening and treatment of HTN among Hui population should be given due attention.

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          Most cited references49

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          Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

          Summary Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding Bill & Melinda Gates Foundation.
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            Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data.

            There currently does not exist guidance for authors aiming to undertake systematic reviews of observational epidemiological studies, such as those reporting prevalence and incidence information. These reviews are particularly useful to measure global disease burden and changes in disease over time. The aim of this article is to provide guidance for conducting these types of reviews.
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              Status of Hypertension in China

              Although the prevalence of hypertension (HTN) continues to increase in developing countries, including China, recent data are lacking. A nationwide survey was conducted from October 2012 to December 2015 to assess the prevalence of HTN in China.

                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Lippincott Williams & Wilkins (Hagerstown, MD )
                0025-7974
                1536-5964
                07 May 2021
                07 May 2021
                : 100
                : 18
                : e25192
                Affiliations
                [a ]Evidence-Based Nursing Center, School of Nursing, Lanzhou University
                [b ]Department of Nursing, the Third People's Hospital of Lanzhou, Lanzhou, China.
                Author notes
                []Correspondence: Yuxia Ma, Evidence-Based Nursing Center, School of Nursing of Lanzhou University, Lanzhou, 730000, China (e-mail: yuxiama@ 123456lzu.edu.cn ).
                Author information
                http://orcid.org/0000-0002-1229-7556
                Article
                MD-D-20-07578 25192
                10.1097/MD.0000000000025192
                8104273
                33950917
                6355387d-5888-49a6-85a4-cef213a7dcc4
                Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0

                History
                : 30 July 2020
                : 15 January 2021
                : 15 February 2021
                Funding
                Funded by: National Nature Science Foundation of China
                Award ID: 71704071
                Award Recipient : Yuxia Ma
                Funded by: the Fundamental Research Funds for the Central Universities
                Award ID: lzujbky-2020-10
                Award Recipient : Fanghong Yan
                Funded by: The National Social Science Fund of China
                Award ID: 20CGL053
                Award Recipient : Fanghong Yan
                Funded by: Nature Science Foundation of Gansu Province
                Award ID: 20JR10RA603
                Award Recipient : Not Applicable
                Categories
                3400
                Research Article
                Systematic Review and Meta-Analysis
                Custom metadata
                TRUE

                hui population,hypertension,prevalence,risk factors
                hui population, hypertension, prevalence, risk factors

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