1. presented by Trevor Ferguson on behalf of JHLS-III Investigators
Jamaica Health and Lifestyle Survey : Prevalence of NCD Risk Factors and Cardiovascular Disease
presented by
Trevor Ferguson on behalf of JHLS-III Investigators

2. Introduction – NCDs and Public Health
Noncommunicable diseases (NCDs), including heart disease, stroke, cancer, diabetes, and chronic lung disease remain a global public health problem
NCDs are responsible for 71% of deaths globally
In Jamaica, NCDs accounted for approximately 62% of deaths among men and 74% of deaths among women in 2016

3. Introduction – NCDs and Public Health
Data from JHLS-II, completed in , showed high prevalence of behavioural and metabolic risk factors for NCDs
JHLS-III, conducted between , provides updated estimates on the burden of NCDs and their risk factors

4. Content Covered Obesity Diabetes mellitus Hypertension
High Cholesterol
Heart Attack
Stroke

5. Study Design
A community based interviewer-administered health examination survey of non-institutionalised Jamaicans, resident in Jamaica, aged 15 years and older
Designed to be nationally representative
Multi-stage sampling design
Randomly selected rural and urban enumeration districts stratified by parish
Systematic sampling of households within each ED
One participant selected per household – using Kish method

6. Weighted Analyses Sampling weights – based on
Probability of selection of dwellings and enumeration districts
Adjusted for unit non-response
Calibrated using population distribution at parish-level sex-specific by 5-year age bands

7. Weighted Estimates
More conservative estimates of the variability associated with the statistics
Description that can be generalised to Jamaican population of 15 years and older

8. Recruitment

9. The Recruited Sample 1089 (38.8%) males, 1718 (61.2%) females Males
Total
Kingston 74
189
263
St. Andrew
125
246
371
St Thomas 66 98
164
Portland 82
122
204
St. Mary 70
152
St Ann 57 59
116
Trelawny 76
135
211
Males
Females
Total
St James 73
126
199
Hanover 60 75
135
Westmoreland 52 98
150
St Elizabeth
109
132
241
Manchester 94
118
212
Clarendon 70
110
180
St Catherine 81
128
209
1089 (38.8%) males, 1718 (61.2%) females

10. RESULTS

11. Distribution of Nutritional Status by Sex (BMI categories)
54% of persons ≥15 yrs were overweight
(25% pre-obese; 29% obese)
Pre-obese = BMI ; Obese = BMI≥30 kg/m2
p<0.001 for male: female difference

12. Pre-Obesity and Obesity by Age
High prevalence of overweight (pre- obesity and obesity) in all age groups
Lowest in age group
Highest among those & years
Small decrease in the older age groups
P<0.001 for difference in proportion for obesity by age (pp )
Pre-obese = BMI ; Obese = BMI≥30 kg/m2

13. Prevalence of obesity by sex (BMI ≥30 kg/m2)
Marked sex difference in prevalence of obesity – female >> male

14. Prevalence of Obesity (BMI ≥30) by Parish (Females)
Highest prevalence: Trelawny (58.0%) , St James (47.0%) , Kingston (46.1%)
Lowest prevalence: Manchester (32.2%), St Mary (34.5%), St Ann (36.6%)

15. Prevalence of Obesity (BMI ≥30) by Parish (Males)
Highest prevalence: Hanover (22.9%) , St Catherine (22.0%), St Ann (19.5%)
Lowest prevalence: Westmoreland (2.0%), Portland (4.2%), St Thomas (7.6%)

16. Prevalence Diabetes Mellitus (defined as FBS ≥ 7
Prevalence Diabetes Mellitus (defined as FBS ≥ 7.0 mmol/l or on medication for diabetes)
Overall diabetes prevalence 11.9% (95%CI %)
Significantly higher prevalence among women 15% vs. 9% (p<0.001)
Prevalence among persons years 10.2% (95% CI %)
Absolute increase of 2.3% compared to JHLS-II in 2008

17. Prevalence of Diabetes Mellitus by Agepp
P<0.001 for both males and females

18. Prevalence of Diabetes by Parish (Females)
Female (p=0.167)
Highest prevalence: Manchester (22%) , Westmoreland (21%), Trelawny (19%)
Lowest prevalence: St Mary (8%), St Ann (9%), Portland (12%)

19. Prevalence of Diabetes by Parish (Males)
Male (p=0.038)
Highest prevalence: Hanover (19%) , Clarendon (19%), Kingston (17%)
Lowest prevalence: St Thomas (2%), St Mary (4%), Trelawny (4%)

20. Prevalence of Diabetes Mellitus by Rural / Urban Residence
No significant differences between rural and urban residents
11.4% among rural vs % among urban residents

21. Overall 24% of persons 15 years or older have diabetes or prediabetes
Pre-diabetes by Sex
Prediabetes defined as fasting glucose of mmol/l
Sex Category
Pre-diabetes (%)
Male
10.7
Female
13.1
Both Sexes
12.0
p<0.001
Overall 24% of persons 15 years or older have diabetes or prediabetes

22. Definition & Classification of High BP
JNC 7 (2003)
Normal
SBP <120 mmHg
&
DBP <80 mmHg
Prehypertension
SBP mmHg or
DBP mmHg
Hypertension
SBP ≥140 mmHg or
DBP ≥90 mmHg
ACC/AHA 2017
Normal
SBP <120 mmHg
&
DBP <80 mmHg
Elevated BP
SBP mmHg or
Hypertension
SBP ≥130 mmHg or
DBP ≥80 mmHg
JNC7 = The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 

23. Prevalence of Hypertension by Sex using JNC-7 (2003) and ACC/AHA (2017) criteria
ACC/AHA 2017 (SBP ≥130 or DBP ≥80)
JNC-7 (SBP ≥140 or DBP ≥90)
p=0.039
p=0.506

24. Proportion of Population in Blood Pressure Categories (JNC-7 & ACC/AHA)%
Normal
32.2
Prehypertension
34.0
Hypertension
33.8
ACC/AHA 2017 %
Normal
32.2
Elevated BP
10.2
Hypertension
57.6
Only 32% of Jamaican adults have normal blood pressure
2/3 of the population have elevated blood pressure

25. Hypertension by Age and Sex (JNC7)
P<0.001 for both males and females

26. Hypertension – Rural vs Urban (JNC7)
No significant rural urban differences in the prevalence of HTN
34.5% rural vs 33.1% urban

27. Hypertension by Parish (JNC7)

28. Prevalence of High Cholesterol (total cholesterol ≥5.2 mmol/l)
Estimated prevalence of high cholesterol = 18%
Higher in women compared to men 20% vs. 16%, p=0.024
Urban vs. Rural
Rural prevalence 20%; urban prevalence 16%; p=0.083
Rural urban difference significant among females: 23% (rural) vs. 17% (urban); p=0.036
Rural urban difference

29. Prevalence of High Cholesterol by Age
P<0.001 for both males and females

30. Hypertension and Diabetes by BMI Category
BMI categories: <18.5 = underweight; = normal weight; = pre-obese; ≥30 = obese (units = kg/m2)

31. Level of Awareness (%) for HTN & DM

32. Treatment and Control (%) among Persons Aware of HTN, DM
Male %
Female
Both Sexes
Hypertension
On Treatment
63.3
73.2
70.2
Controlled1
26.0
33.1
31.0
Diabetes
91.3
93.0
92.5
29.0
27.0
27.5
1 Controlled calculated as proportion of those on treatment

33. Prevalence of Heart Attack by Sex and Age
Overall prevalence of heart attack 0.4% (4.2 per 1000)
Prevalence is lower than 0.6% seen in 2008
As expected no cases among persons <35; absence of cases in probably due to chance given the small numbers

34. Prevalence of Stroke by Sex and Age
Overall prevalence of stroke was 1.2% (10 per 1000)
Prevalence is slightly lower than 1.4% seen in 2008
No cases among persons <25; high prevalence among persons ≥75 years

35. Secular Trends among persons 15-74 years for 2001, 2008, 2017
Condition
2001 %
2008
2017
% Change
Pre-obese/Obese
45.7
51.8
53.9
17.9
Obesity
19.7
25.3
28.9
46.7
Hypertension
20.9
25.2
31.5
50.7
Diabetes mellitus
7.2
7.9
10.2
41.7
High Cholesterol
14.6
11.7
17.1

36. Summary / Key Findings
Prevalence of NCD risk factors remain high and appear to be increasing
More than half of the population is pre-obese/obese
2/3 have elevated blood pressure
1/8 have diabetes; ¼ had pre-diabetes or diabetes combined
Just under 1/5 have high cholesterol
4/10 persons with HTN or DM unaware of their condition
Only 30% of treated persons with HTN or DM are controlled

37. Implications
Jamaica will to continue to face challenges with complications of diabetes & hypertension, particularly heart disease, stroke & chronic kidney disease
Health care expenditure is likely to increase
May negatively impact economy due to reduced productivity among persons who are ill
Likely to see increase in dependency ratio due to more persons being unable to work

38. Recommendations
Population wide intervention to reduce obesity, diabetes and hypertension
Jamaica Moves  programme - physical activity, healthy eating; promotion of age-appropriate health checks for NCDs and NCD awareness.
Improved socioeconomic circumstances and improved access to care
Population wide screening for hypertension, diabetes and high cholesterol to increase awareness and ensure persons are treated
Engagement of health care providers in both public and private sector to improve quality of care

39. JHLS-III Research Team
Rainford
Wilks
Karen
Webster
Marshall
Tulloch-Reid
Shelly
McFarlane
Andriene
Grant
Novie
Younger-Coleman
Nadia
Bennett
Trevor
Ferguson
Tamu
Davidson
Colette
Cunningham-Myrie
Damian
Francis
Ishtar
Govia
Suzanne
Soares-Wynter
William
Aiken
Shari
Williams
Jovan
Wiggan
Nicolas
Elias
Georgiana
Gordon-Strachan
Tiffany
Palmer
Natalie
Guthrie
Georgia
Williamson
Ardene
Harris
Sharmaine
Edwards