Prevalence, Management, and Associated Factors of Obesity, Hypertension, and Diabetes In Tibetan Population Compared with China Overall

Abstract

Background: Tibetans’ life expectancy lags behind China’s national average. Obesity and noncommunicable diseases (NCDs) contribute to the health disparity, but NCD patterns among Tibetans are unknown. This systematic review and meta-analysis examined prevalence, management, and associated factors for obesity, hypertension, and diabetes among Tibetans and compared them with China's average. Methods: We systematically searched PubMed and China National Knowledge Infrastructure databases for studies published in English and Chinese between January 2010 and April 2021. Pooled prevalence estimates were calculated using random-effects models. China’s national estimates were from nationally representative surveillance. PRISMA guidelines were followed. Findings: Thirty-nine studies were included for systematic review, among which 37 qualified for meta-analysis, with 115,403 participants. Studies included were geographically diverse in altitude, livelihood, and urban/rural residence. Pooled prevalence estimates were 47·9% (95% CI 38·0-57·8) for overweight/obesity among adults (BMI≥24kg/m 2 ), and 15·4% (13·7-17·2) among children using Chinese criteria, lower than national rates of 51·2% and 19·0%, respectively. The estimate for hypertension (31·4% [27·1-35·7]) exceeded China’s average (27·5%), while diabetes (7·5% [5·2-9·8]) was lower than China’s average (11·9%). Men had higher prevalence estimates of overweight/obesity, hypertension, and diabetes than women. Residents in urban, rural, and Buddhist institutes had monotonically decreased prevalence estimates in both hypertension and diabetes. Awareness, treatment, and control rates for hypertension were lower than China's average. Findings on diabetes management were similar based on limited studies. Urban residence and high altitude were consistent risk factors for hypertension. Limited studies investigated factors associated with diabetes, and none for obesity. Interpretation: Tibetans have a high burden of obesity and hypertension. Further research is required to clarify the low diabetes prevalence found. Representative and longitudinal studies are needed for interventions tailored to the Tibetan population, evidence-based and culturally-sensitive policy development, and health equity. Registration Details: Study protocol was registered with PROSPERO, number CRD42021255694. Funding Information: The study was funded in part by research grants from the National Key Research & Development Program of China (2017YFC0907200 & 2017YFC0907201), Natural Scientific Foundation of China (82103846) and Chinese Nutrition Society (CNS-SCP-2020-40). Declaration of Interests: We declare no conflict of interest.