Abstract
BackgroundThe extent to which rural-to-urban migration affects risk for cardiometabolic diseases (CMD) in Africa is not well understood. We investigated prevalence and risk for obesity, diabetes, hypertension and precursor conditions by migration status.MethodsIn a cross-sectional survey in Malawi (February 2013–March 2017), 13 903 rural, 9929 rural-to-urban migrant and 6741 urban residents (≥18 years old) participated. We interviewed participants, measured blood pressure and collected anthropometric data and fasting blood samples to estimate population prevalences and odds ratios, using negative binomial regression, for CMD, by migration status. In a sub-cohort of 131 rural–urban siblings-sets, migration-associated CMD risk was explored using conditional Poisson regression.ResultsIn rural, rural-to-urban migrant and urban residents, prevalence estimates were; 8.9, 20.9 and 15.2% in men and 25.4, 43.9 and 39.3% in women for overweight/obesity; 1.4, 2.9 and 1.9% in men and 1.5, 2.8 and 1.7% in women for diabetes; and 13.4, 18.8 and 12.2% in men and 13.7, 15.8 and 10.2% in women for hypertension. Rural-to-urban migrants had the greatest risk for hypertension (adjusted relative risk for men 1.18; 95% confidence interval 1.04–1.34 and women 1.17: 95% confidence interval 1.05–1.29) and were the most screened, diagnosed and treated for CMD, compared with urban residents. Within sibling sets, rural-to-urban migrant siblings had a higher risk for overweight and pre-hypertension, with no evidence for differences by duration of stay.ConclusionsRural-to-urban migration is associated with increased CMD risk in Malawi. In a poor country experiencing rapid urbanization, interventions for the prevention and management of CMD, which reach migrant populations, are needed.
Highlights
Urbanization is shaping epidemiological and demographic transition in sub-Saharan Africa (SSA).[1]
Rural-to-urban migration is associated with increased cardiometabolic diseases (CMD) risk in Malawi
Higher prevalences of obesity, hypertension and their precursor states were observed in urban migrant siblings compared with their rural non-migrant siblings
Summary
Urbanization is shaping epidemiological and demographic transition in sub-Saharan Africa (SSA).[1]. A 2009 national STEPwise approach to Surveillance (STEPS) prevalence survey reported 27% overweight/obesity, 33% hypertension and 6% diabetes, with higher prevalences of all conditions in urban compared with rural adults.[6] Data on migrant populations were not available. A more recent population-based survey comparing urban to rural adults (n 1⁄4 29 000) showed higher prevalences of overweight/obesity (40 vs 20%), hypertension (23 vs 15%) and diabetes (5 vs 2%) in urban compared with rural residents.[7]. Results: In rural, rural-to-urban migrant and urban residents, prevalence estimates were; 8.9, 20.9 and 15.2% in men and 25.4, 43.9 and 39.3% in women for overweight/obesity; 1.4, 2.9 and 1.9% in men and 1.5, 2.8 and 1.7% in women for diabetes; and 13.4, 18.8 and 12.2% in men and 13.7, 15.8 and 10.2% in women for hypertension. Rural-to-urban migrant siblings had a higher risk for overweight and pre-hypertension, with no evidence for differences by duration of stay
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