Published by: Statistical Analysis Section Issue: 7 July - Sep 2006

Hypertensiive Diiseases iin Dubaii Hypertens ve D seases n Duba

Welcome to the seventh Statistical Newsletter issued by the Statistical Analysis Section, Planning and Statistical Department. On the occasion of the World Heart Day, the Statistical Analysis Section has the honor to release a Statistical Newsletter that discussed hypertensive diseases in Dubai, mortality of Cardiovascular diseases and hypertensive disorders in pregnancy. Hope the newsletter proves beneficial with regards to your profession. Your comments are welcome.

Raised blood pressure is a massive health problem in almost every country. It is one of the most important underlying risk factors for morbidity and mortality in the world today, ranking alongside tobacco in estimates of the worldwide attributable burden of mortality. Population studies suggest that blood pressure in excess of 140/90 mmHg is found in nearly 30% of adults. In addition, Hypertension is already a highly prevalent cardiovascular risk factor worldwide because of increasing longevity and prevalence of contributing factors such as obesity. Whereas the treatment of hypertension has been shown to prevent cardiovascular diseases and to extend and enhance life, hypertension remains inadequately managed everywhere (1-5).
Cardiovascular diseases (CVD) amounted to 28% of all deaths in UAE in 2003. In Dubai, it amounted to 31.4% of all deaths in 2005. Inpatient cardiovascular diseases amounted to 3919 (8.49%) of all admitted cases in DOHMS in 2005. Hypertensive diseases constituted 9.8% of all the admitted cases of CVD in DOHMS and were more frequent among females (17.0%). It is one of the ten leading causes of death among Emirates in 2005. There were 386 cases admitted in DOHMS, 147 (38.1%) were Emirates and 61.9% were Expatriates, (Figure 1). Among the Emirate population, 72 (49.0%) were males and 51.0% were females. The frequency distribution of hypertension increased with increase in age, but hypertension was more prevalent among females in the age group 45-64 years and males in the age group 65 years and above. Out of 237055 outpatient cases diagnosed by specialist in DOHMS in 2005, there were 13497 cases of CVD with a rate of 5.7%. Hypertensive diseases amounted for more than two fifths of the cases (43.46%). Studying hypertensive heart diseases among persons diagnosed by specialist, there were 1132 (45.24%) males and 1371 (54.77%) females. The frequency distribution of the diseases increased with increase in age. There was a significant difference between males and females regarding distribution of hypertensive heart diseases by age, (P=0.02). The mean age for Emirates population was 61.21 13.08. It was 62.62 13.01 years for males and 60.44 13.07 for females. This difference is significant. The mean number of visit was 2.44 1.67 visits with no significant difference between males and females. Studying the distribution of hypertensive diseases by type, essential hypertension amounted to 93.0%, hypertensive heart disease, renal heart disease (3.7%) and secondary hypertension 3.3%, (Figure 2). There was a significant difference between males and females in the distribution of hypertensive heart disease by type.

From the

Inside this issue: Hypertensive Diseases in Dubai Cardiovascular Diseases mortality Hypertensive Disorders in pregnancy

Figure (1) Distribution of Hypertensive Heart Diseases among Inpatients in DOHMS by Nationality in 2005

Figure (2) Distribution of Hypertensive Heart Diseases in DOHMS among Emirate Outpatients to Specialist Clinics, Dubai 2005

Statistical Analysis Section Planning & Statistics Department Department of Health & Medical Services Dubai - United Arab Emirates
62%

4%

3%

38%

93%

Emirate

Expatriate

Essential

Heart & Renal

Secondary

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Out of the 2556 (CVD) cases admitted in Private health sector facilities in Dubai in 2005, 214 (8.4%) were hypertensive diseases. As for outpatient cases, there were 64299 outpatient attendances of cardiovascular diseases. Hypertension diseases amounted for about two thirds (62.4%) of the attended cases. Recommendation: Carrying out an integrated survey to determine the prevalence of hypertension in Dubai and study the important risk factors of the disease. Developing a program for management and control of hypertension within non-communicable diseases control program and integration of its activities through primary health care. References:
1. Wiist WL and Flack .Epidemiology of hypertension and hypertensive targetorgan damage in the United States. J Assoc Acad Minor Phys. 1991; 2(4):143-50. in http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&l ist_uids=1839824&dopt=Abstract American Journal of Epidemiology Vol. 153, No. 7 : 715-716 in http://aje.oxfordjournals.org/cgi/content/full/153/7/715 Elliott P. High blood pressure in the community. In: Bulpitt CJ, ed. Handbook of hypertension. Vol. 20. Epidemiology of hypertension. Amsterdam, the Netherlands: Elsevier Scientific B.V., 2000:118. Ezzati M, Lopez AD, Rodgers A, et al. Selected major risk factors and global and regional burden of disease. Lancet. 2002; 360:1347-1360. Paul K. Whelton, Epidemiology and the Prevention of Hypertension in http://www.medscape.com/vi ewarticle/494336

diseases had the highest CFR (16.2%), Table 1. Dubai population cases had more than two and half times increased risk of CVD deaths (OR= 2.6, CI = 1.59, 4.27; P=0.00003) than other Emirates population in Dubai. Studying the risk factors of deaths for CVDs in DOHMS hospitals, those aged 55 years and above, Dubai population and cerebrovascular disease cases had higher risk of mortality than relevant categories, Table 2. Applying logistic regression analysis to assess the independent influence of each variable on death from cardiovascular diseases, adjusted risks associated with those aged 55 years and above, Dubai population and cerebrovascular disease cases were significantly increased compared to the relevant different categories, Table 3.
Table (1) Summary characteristics of Hospital Cardiovascular Disease Mortality in DOHMS according to Some Epidemiological characteristics, Dubai 2000- 2006 Viable Age (CFR %) < 55 years 55 years Dubai Population (CFR %) Dubai Other Emirates Sex (CFR %) Males Females Hospital (CFR %) Dubai Rashid Year (CFR %) 2004 2005 2006 Diagnosis (CFR %) Cerebrovascular Disease Hypertensive Disease Ischaemic Heart Disease Other Cardiovascular Disease 4.58 4.50 5.92 x2 =2.27 P = 0.31 Value 1.91 5.58 5.47 2.18 4.07 5.16 Significance x2= 20.75 P = 0.0001 x2 = 17.1 P = 0.000 x2 = 2.188 P = 0.139

2. 3. 4. 5.

Cardiiovascullar Diiseases Mortalliity Card ovascu ar D seases Morta ty among Emiirate Inpatiients iin Dubaii among Em rate Inpat ents n Duba
Background and objectives: Cardiovascular diseases (CVD) have been identified as the primary non- communicable health problem throughout the world .It accounted for 29.2% of total global deaths according to World Health Report 2003. CVD amounted to 31.4% of all deaths in Dubai; 2005.The study was carried out with the aim of studying the nature of CVDs hospital mortality in the Department of Health and Medical Services (DOHMS), Dubai, UAE.

4.85 4.91

x2 = 0.0045 P = 0.946

16.62 3.32 0.8 3.39

x2 = 152.86 P = 0.0001

Table (2) Crude Odds Ratio of Cardiovascular Disease Mortality in DOHMS hospital by certain Epidemiological variables, Dubai 2000- 2006 Variable Dubai Population Other Emirates v. Dubai. Age 55 years v. < 55 years Diagnosis Cerebrovascular v. other CVD Crude Odds Ratio 0.385 (0.241,0.651) x2 17.09 P <0.0001

Methods: The study was basically a retrospective case series. The information was collected from the electronic network of health information system in DOHMS. Retrospective case series of cardiovascular diseases discharged during the period 2000- 2006 were reviewed. Basic data were age, sex, nationality, diagnosis, outcome at discharge and month of admission. The whole group of records was firstly described within the categories of the different variables. Crude adds ratio was calculated. Logistic regression model was applied for assessing the independent influence of each variable on mortality. Results: Out of the 3266 cases of CVD admitted in DOHMS, there were 147 deaths with a case fatality rate (CFR) of 4.5%. Comparing the CFR in the different years, it was nearly the same. The rate was almost equal in different hospitals. Cerebrovascular
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3.02 (1.83, 4.99)

20.75

0.0001

652 (4.07, 9.41)

146.52

0.0001

Conclusion: The results of the study show that Dubai people, those aged 55 years and cerebrovascular disease cases were at an increased risk of death from CVD. There is a need to develop and implement a plan for the management and control of CVD in Dubai References:
1. Clinical guidelines for the management of hypertension http://www.emro.who.int/publications/Book_Details.asp?ID=191

Table (1) Summary characteristics of Hypertensive disorders in Pregnancy in DOHMS according to Some Epidemiological characteristics, Dubai 2005 Variable Age (% of hypertension) < 35 years 35 years Nationality (% of hypertension) Emirates Expatriates 1.98 3.27 1.99 2.52 x2= 17.72 P = 0.000 x2= 4.78 P = 0.0288 Value Significance

Table (3) Point Estimate of Cardiovascular Diseases Mortality in DOHMS by Certain Epidemiological Variables, Dubai 2000- 2006 Variable Age (55 years v. < 55 years) Diagnosis (Cerebrovascular Diseases v. other CVD) Dubai Population Dubai v. Other Emirates Point Estimate 2.55(1.53, 4.24) P 0.0003

Table (2) Crude Odds Ratio of Hypertensive disorders in Pregnancy in DOHMS hospital by certain Epidemiological variables, Dubai 2005 Variable Age 35 years v. < 35 years Nationality Expatriates v. Emirates Crude Odds Ratio 1.677 (1.32, 2.14) 1.27(1.02, 1.58) x2 17.22 4.78 P 0.0001 0.029

5.83 (4.09, 8.3) 2.41 (1.47, 3.96)

0.001 0.005

Hypertensiive Diisorders iin Pregnancy Hypertens ve D sorders n Pregnancy

It amounts to 7 per thousand of all admitted cases in 2005 in DOHMS. The mean age of the studied cases was 30.85 5.7 years. Pre-existing hypertension amounted to 3.2% of the cases, 24.2% were gestational hypertension, 0.9% eclampsia and 70.24% were unspecified material hypertension. Emirates amounted for 54.46% of the cases. Table (1) shows that hypertensive disorders in pregnancy amounted for 1.98% of all cases admitted in pregnancy, childbirth and puerperium period among those below 35 and 3.27% in the age group 35 years and above. This difference is significant. Expatriates had higher percentage (2.52%) of hypertension diseases in pregnancy than nationals (1.99%) with a significant difference (P=0.02). Table (2) shows that pregnant women aged 35 years and above had more than one and half times increased risk of hypertension than those below 35 years (cOR=1.677 (1.32, 2.14), P=0.0001). Expatriates had more increased risk than Emirates (cOR=1.27 (1.02, 1.58), P=0.02). By applying logistic regression model, adjusted risks associated with those aged 35 years and above and Expatriates were significantly increased compared to the different relevant categories, Table (3).

Table (3) Point Estimate of Hypertensive disorders in Pregnancy in DOHMS by Certain Epidemiological Variables, Dubai 2005 Variable Age 35 years v. < 35 years Nationality Emirates v. Expatriates 0.796 (0.64, 0.99) 0.003 1.656 (1.29,2.11) 0.001 Point Estimate P

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