Trends in cardiometabolic risk factors in the Americas between 1980 and 2014: a pooled analysis of population-based surveys

Abstract

Background: Describing the prevalence and trends of cardiometabolic risk factors that are associated with non-communicable diseases (NCDs) is crucial for monitoring progress, planning prevention, and providing evidence to support policy efforts. We aimed to analyse the transition in body-mass index (BMI), obesity, blood pressure, raised blood pressure, and diabetes in the Americas, between 1980 and 2014.

Methods: We did a pooled analysis of population-based studies with data on anthropometric measurements, biomarkers for diabetes, and blood pressure from adults aged 18 years or older. A Bayesian model was used to estimate trends in BMI, raised blood pressure (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg), and diabetes (fasting plasma glucose ≥7·0 mmol/L, history of diabetes, or diabetes treatment) from 1980 to 2014, in 37 countries and six subregions of the Americas.

Findings: 389 population-based surveys from the Americas were available. Comparing prevalence estimates from 2014 with those of 1980, in the non-English speaking Caribbean subregion, the prevalence of obesity increased from 3·9% (95% CI 2·2-6·3) in 1980, to 18·6% (14·3-23·3) in 2014, in men; and from 12·2% (8·2-17·0) in 1980, to 30·5% (25·7-35·5) in 2014, in women. The English-speaking Caribbean subregion had the largest increase in the prevalence of diabetes, from 5·2% (2·1-10·4) in men and 6·4% (2·6-10·4) in women in 1980, to 11·1% (6·4-17·3) in men and 13·6% (8·2-21·0) in women in 2014). Conversely, the prevalence of raised blood pressure has decreased in all subregions; the largest decrease was found in North America from 27·6% (22·3-33·2) in men and 19·9% (15·8-24·4) in women in 1980, to 15·5% (11·1-20·9) in men and 10·7% (7·7-14·5) in women in 2014.

Interpretation: Despite the generally high prevalence of cardiometabolic risk factors across the Americas, estimates also showed a high level of heterogeneity in the transition between countries. The increasing prevalence of obesity and diabetes observed over time requires appropriate measures to deal with these public health challenges. Our results support a diversification of health interventions across subregions and countries.

Funding: Wellcome Trust.

Figure 1

Number of data sources available for body-mass index, blood pressure, and diabetes by subregion and year

Figure 2

Trends in age-standardised prevalence of obesity, raised blood pressure, and diabetes by subregion in men and women The lines show the posterior mean estimates and the shaded areas show the 95% credible intervals.

Figure 3

Boxplot showing the distribution of of country-level obesity, raised blood pressure, and diabetes prevalence Coloured boxes show how country-level prevalences are distributed within subregions (as opposed to population-weighted subregional means), and large uncoloured boxes show the country-level distributions for the Americas as a whole. Solid lines show medians, the boxes show IQRs, and the whiskers show ranges.

Figure 4

Heatmap of age-standardised prevalence of obesity, raised blood pressure, and diabetes by country in men and women in 2014, and proportional change from 1980 Countries are ranked by the prevalence of obesity. The ratio of prevalence for each risk factor are calculated for 2014 values relative to 1980 estimates. For the first three columns, red indicates the highest level in the prevalence of that specific risk factor and white the lowest; for the last three columns, purple indicates the highest ratio of prevalence and white the lowest.

Figure 4

Heatmap of age-standardised prevalence of obesity, raised blood pressure, and diabetes by country in men and women in 2014, and proportional change from 1980 Countries are ranked by the prevalence of obesity. The ratio of prevalence for each risk factor are calculated for 2014 values relative to 1980 estimates. For the first three columns, red indicates the highest level in the prevalence of that specific risk factor and white the lowest; for the last three columns, purple indicates the highest ratio of prevalence and white the lowest.

Figure 5

Male vs female age-standardised prevalence of obesity, raised blood pressure, and diabetes in 1980 and 2014