Social Determinants of Undiagnosed Diabetes and Hypertension among Older Adults in Rural Bangladesh: Evidence from an Implementation Research
1
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
2
Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
3
Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Undiagnosed diabetes mellitus (DM) and hypertension (HTN) are major causes of avoidable complications among older adults in low-resource settings. Evidence from rural Bangladesh on how health system-based screening reaches socially vulnerable older people remains limited.
METHODS:
A population-based implementation research was conducted from January-June 2019 in Sirajganj District, following the WHO-Package of Essential Noncommunicable Disease Interventions (PEN)(1). All adults aged 18-years and above were enumerated at household level and referred for DM and HTN screening at Community Clinics (CC), with confirmatory testing at the Upazila Health Complex (UHC). Undiagnosed DM and HTN were defined as individuals not previously diagnosed but newly confirmed through this program. Among the 22,109 enumerated adults, 3,145 were aged 60 years and above and were included in the descriptive and multivariable regression analyses.
RESULTS:
The mean age was 69.5 years and 53% were women. Nearly 64% had no formal education and 86% lived in households earning ≤15,000 BDT per month. The prevalence of undiagnosed DM and HTN was 2.4% and 11.8%, respectively. Low education was associated with higher odds of undiagnosed DM (OR 2.4, 95% CI 1.2-4.4). Undiagnosed HTN was more likely among those with low income (OR 1.9, 95% CI 1.2-2.9), low education (OR 1.6, 95% CI 1.1-2.2) and engaged in farming. Excess salt intake (64% vs 50.6%), current smoking (12.4% vs 8.6%), and unhealthy dietary practices (54.3% vs 50.3%) were more common among undiagnosed HTN than among pre-diagnosed cases. Care-seeking attrition was high, with 39.6% not attending community clinic screening, and 56% of those referred from CC failing to attend UHC diagnostic care.
CONCLUSIONS:
Substantial hidden burden of diabetes and hypertension exists among older people in rural Bangladesh. Social disadvantage and weak continuity of care prevent timely diagnosis, underscoring the need for older adult focused, equity driven NCD screening strategies within primary healthcare.
Undiagnosed diabetes mellitus (DM) and hypertension (HTN) are major causes of avoidable complications among older adults in low-resource settings. Evidence from rural Bangladesh on how health system-based screening reaches socially vulnerable older people remains limited.
METHODS:
A population-based implementation research was conducted from January-June 2019 in Sirajganj District, following the WHO-Package of Essential Noncommunicable Disease Interventions (PEN)(1). All adults aged 18-years and above were enumerated at household level and referred for DM and HTN screening at Community Clinics (CC), with confirmatory testing at the Upazila Health Complex (UHC). Undiagnosed DM and HTN were defined as individuals not previously diagnosed but newly confirmed through this program. Among the 22,109 enumerated adults, 3,145 were aged 60 years and above and were included in the descriptive and multivariable regression analyses.
RESULTS:
The mean age was 69.5 years and 53% were women. Nearly 64% had no formal education and 86% lived in households earning ≤15,000 BDT per month. The prevalence of undiagnosed DM and HTN was 2.4% and 11.8%, respectively. Low education was associated with higher odds of undiagnosed DM (OR 2.4, 95% CI 1.2-4.4). Undiagnosed HTN was more likely among those with low income (OR 1.9, 95% CI 1.2-2.9), low education (OR 1.6, 95% CI 1.1-2.2) and engaged in farming. Excess salt intake (64% vs 50.6%), current smoking (12.4% vs 8.6%), and unhealthy dietary practices (54.3% vs 50.3%) were more common among undiagnosed HTN than among pre-diagnosed cases. Care-seeking attrition was high, with 39.6% not attending community clinic screening, and 56% of those referred from CC failing to attend UHC diagnostic care.
CONCLUSIONS:
Substantial hidden burden of diabetes and hypertension exists among older people in rural Bangladesh. Social disadvantage and weak continuity of care prevent timely diagnosis, underscoring the need for older adult focused, equity driven NCD screening strategies within primary healthcare.
| eISSN: | 2654-1459 |
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