Prevalence and Determinants of Hypertension among pensioners in Three Districts of Kigali City, Rwanda, 2023: A Cross-Sectional Study

doi:10.21203/rs.3.rs-5283967/v1

Background

Hypertension is escalating daily, presenting an increasing public health challenge in Rwanda. Despite aging being a significant contributor to Non-communicable Diseases (NCDs), the prevalence and contributing factors of hypertension among pensioners have not been adequately studied.

Objective

The study aimed to assess the prevalence of hypertension and the factors associated with it among pensioners in three districts of Kigali City.

Methods

The study employed a cross-sectional, quantitative research design utilizing a multistage sampling method. Researchers included 220 participants from Kigali and collected data from July 5th to August 20th, 2023. They used a structured questionnaire to gather information, encompassing socio-demographic and behavioral data. Multivariable logistic regression analysis was performed to identify factors associated with hypertension.

Results

Out of the 220 participants, 53.18% had hypertension, with men representing the majority at 65.81%. Individuals who tested positive for HIV/AIDS had 18.4 times higher odds of developing hypertension (adjusted OR: 18.405, 95% C.I = 3.228–104.93) compared to those without HIV/AIDS. Those diagnosed with Diabetes mellitus (DM) had 16.8 times higher odds of developing hypertension (adjusted OR: 16.873, 95% C.I = 1.591–178.84) compared to those without Diabetes mellitus (DM). Participants experiencing occasional stress at work had 2.9 times higher odds of developing hypertension (adjusted OR: 2.902, 95% C.I = 1.200-7.021) compared to those who never experienced stress at work. Those facing frequent stress at work (adjusted OR: 13.514, 95% C.I = 2.205–82.825) exhibited higher odds of developing hypertension.

Conclusion

The study identified a significant prevalence of hypertension among pensioners, associating HIV/AIDS, diabetes, and occupational stress as contributing factors. This underscores the need for widespread campaigns to emphasize HIV prevention, stress management, regular physical activity, and lifestyle changes.

Associated Factors

Hypertension

Pensioners

Prevalence

Nearly one billion individuals worldwide endure hypertension, with two-thirds living in low- and middle-income countries. Hypertension-related illnesses result in 7.5 million deaths annually, accounting for 12.8% of all fatalities. [1] By 2025, developing countries will account for 75% of the global hypertensive population, causing a global economic burden of 370 billion dollars and accounting for 10% of healthcare expenditures. Hypertension will lead to chronic illness or death, leaving families impoverished. [1] According to the 2021 Fidelity Retiree Health Care Cost Estimate, an average 65-year-old couple might need to save $300,000 to cover healthcare expenses during retirement. [2, 3]Unemployment and rapid aging are influencing retirement habits, potentially causing hypertension-related cardiovascular diseases, with significant correlations between NCD incidence, job losses, and retirement. [5, 6] Rural-to-urban migration and inadequate government and development attention contribute to a hypertension epidemic in Africa, particularly among adults, surpassing the prevalence in high-income countries. [7]

The limited allocation of global health aid to non-communicable diseases (NCDs), such as hypertension, with less than 3% spent, underscores the challenges and consequences associated with the rising burden of hypertension in the region. [8]

The World Health Organization states that deaths related to non-communicable diseases (NCDs) in developing countries impact more individuals over 60 years old compared to those under 60 years old.[9] The study reveals that 60% of the 60-year-old population in Africa has hypertension, with men and women experiencing varying rates, with 65% prevalence in men and 75% in women. [10] According to the Ministry of Health report by the Rwanda Biomedical Center on non-communicable diseases (NCDs) in 2022, the incidence of hypertension among individuals aged 60 to 69 was 43.2%. For the broader age group of 18 to 69 years, the prevalence was 16.8%, with the highest rate observed in females. [11].In a study conducted in Mexico, researchers discovered that the occurrence of hypertension rises with age, impacting 68% of individuals over 60, with a marginally higher prevalence in women compared to men. [12] Up to 50% of patients over 65 could be affected. Argentina's hypertension affects 71% of people above 65. [13] By 2030, Africa is projected to have 216.8 million individuals with hypertension. [14] Age, sex, race, socioeconomic status, psychosocial stress, family history, diet, smoking, alcohol consumption, physical inactivity, body weight, and hypertension awareness contribute to risk factors. [1] Research in Malawi and Ethiopia linked hypertension to gender, but found no clear difference in prevalence between genders. [15, 16, 17] Postgraduate degree holders and grade eight graduates have higher rates of hypertension prevalence, significantly influenced by education. [19, 20] Different population groups showed variations in prevalence. [21, 22, 23]

Hypertension afflicts 46% of Rwandan adults, resulting in 730 deaths annually. In Rwanda, 15.9% of individuals aged 15–64 suffer from the condition, with higher rates observed among older individuals. [24, 25] The Rwandan government introduced a nationwide plan to tackle hypertension, which involves offering health insurance to both public and private sector employees. However, limited research exists on factors associated with hypertension in pensioners and its prevalence.

Study Design and Setting

The researchers employed a quantitative descriptive cross-sectional study design to carry out a survey using questionnaires in three districts of Kigali City at a single point in time. The aim was to assess the prevalence and related factors among pensioners. Kigali City, consisting of 3 districts, 35 sectors, 161 cells, and 1155 villages, was the focal area for the study. Data collection took place from July to August 2023; specifically targeting pensioners aged 60 years and older residing in Kigali City.

Study Population and eligibility criteria

The research encompassed all retired salaried men and women from Rwanda who had been employed in either private or public sectors and was aged 60 years or older. The research excluded individuals aged between 60 and 65 years who are currently working in public and private sectors but have not yet retired, as well as those younger than 60 years. The study also excluded foreign individuals and the population whose chronic physical and mental illnesses prevented them from providing information.

Sample size and sampling procedures

The research project included 220 participants who took part within a specified period. According to the NCDs risk factors study in Rwanda for the years 2021–2022, hypertension prevalence among elderly people aged between 60–69 years was 43.2%, while the general population aged between 18–69 years exhibited a prevalence of 16.8%. [11]

The formula utilized to calculate the sample size:

$$\:\mathbf{n}=\frac{\mathbf{z}2\mathbf{P}(1-\mathbf{P})}{\mathbf{e}2}\:=\frac{1.962\mathbf{*}0.432(1-0.432)}{0.052}\:=193$$

Note that:

n : is the sample size.
z : is the z-score (1.96 for a 95% confidence level).
P :is the estimated proportion of the population (0.432 in this case).
e : is the margin of error (0.05 in this case).

The researcher employed a multistage sampling method, recruiting research participants from villages using a random sampling method in clustered cells. The researcher selected participants from three districts, 21 sectors, 37 cells, and 45 villages. Collaborating with Rwanda Social Security Board (RSSB) and Rwandese Association of Retired (ARR), the researcher obtained their locations and lists to locate participants. The required information from RSSB and ARR included the names of pensioners, their ages, the location of pensioners, and their phone numbers.

The researcher utilized names, ages, locations, and phone numbers of participants as part of the sampling method strategy, enabling a systematic approach to participant selection, enhancing geographical representation, and facilitating effective communication and follow-up procedures throughout the research aim. The participants agreed to take part in the study after the researcher clarified the purpose of the research and their roles. The researcher contacted the participants via phone call and obtained their consent. The distribution of the sample size in each district was determined based on a multistage sampling approach, which involved several steps to ensure representative sampling. Initially, the sampling design phase took into account the population size of each district. Subsequently, proportional allocation was utilized to allocate a proportionate sample size to each district relative to its population size. This approach aimed to ensure that each district's sample size adequately represented its population, thus enhancing the study's generalizability and validity of findings.

Data collection instruments, procedures and quality control.

The study utilized a structured interview questionnaire along with physical and biochemical measurements to investigate factors contributing to hypertension among participants. Digital scales and sphygmomanometers were used for measurements to gather data on participants' weight, height, and blood pressure. Additionally, the researcher requested participants via phone to visit the nearest health centers and record their blood pressure, where the second measurement of blood pressure was taken after 1 minute of the first measurement to ensure accurate averages and maintain quality control. During the data collection phase, the researcher also contacted participants by phone to gather information on blood glucose levels and HIV/AIDS status. The study outlines objectives, confidentiality, data security, and the intended use of data. Data collection was carried out using the Kobo Toolbox for data management. The survey was created in English and translated into the local language (Kinyarwanda) to ensure clarity and comprehension for all participants.

Data processing, study variables and analysis

During the study, we evaluated hypertension by determining whether respondents were using antihypertensive medications and by measuring blood pressure during data collection, with an average systolic blood pressure exceeding 140 mmHg and diastolic pressure exceeding 90 mmHg.

The study gathered socio-demographic factors including age, gender, education level, occupation, wealth index, marital status, residence, and health insurance. We also categorized participants based on their diabetes and HIV/AIDS statuses through personal information. Behavioral factors such as tobacco use, alcohol consumption, physical inactivity, BMI, and fruit and vegetable intake were analyzed. Additionally, we examined factors related to occupational stress, including whether participants had worked under stressful conditions and the duration of such work environments.

For descriptive analysis, we used frequencies and percentages. We first reviewed the frequency distributions of socio-demographic and behavioral characteristics of participants. Finally, we applied bivariate and multivariate logistic regression models to identify factors associated with hypertension among pensioners. Logistic regression analysis computed the odds ratios with corresponding 95% confidence intervals. We set the significance level at a P-value less than 0.05. Data analysis was conducted using STATA version 15.1.

Ethical consideration

We verified and secured the requisite approvals from the Research Ethics Committee at the University of Rwanda – College of Medicine and Health Sciences, Institute Review Board (IRB) reference NO: CMHS/IRB/278/2023 to guarantee ethical clearance and scientific validity. Furthermore, we sought guidance from the Rwanda National Ethical Committee (RNEC) FWA Assurance No: 00001973/IRB/00001497 of IOG0001100 to gather information about beneficiaries or clients of RSSB.We obtained written authorization for collecting data from the Rwanda Social Security Board (reference: RSSB/5019/hr/23) and the City of Kigali (reference No:1328/07.01.16/23). We duly informed participants about the study and obtained their informed consent before collecting any data. We treated the information obtained from the participants with respect and maintained it with a high level of confidentiality.

Description of socio-demographic and Co-morbidities characteristics of participants.

220 participants comprised 64.5% men and 35.45% women. Nyarugenge district was the residence for 44% of them. Secondary level of education was attained by a majority (63.64%), and 88.2% were legally married. Pensioners from the local and central government occupied higher proportions (46.82%). The proportion of respondents with HIV/AIDs was 9.09%, while those with diabetes mellitus were 17.27%. See Table 1 for Details.

Pensioners behavioral characteristics and Occupational stress related factors

Fifty-six percent (56.36%) reported a history of tobacco consumption, while 12.39% reported consuming tobacco products at the time of the survey. Furthermore, 83.64% of participants indicated that they had consumed alcohol previously. Among the 146 participants, 66.36% had a BMI of 25 kg/m² or higher, while 33.64% had a BMI within the normal range.Out of 33 participants, 15% had worked in stressful conditions in the past, while 85% had not. Among the respondents, 58.18% had experienced stress at some point in the past, 14.55% had experienced stress several times, and 27.27% had never experienced stress in the workplace. See Table 2 for Details.

Prevalence of Hypertension among Participants

The rate of hypertension among retirees reached 53.18%.The systolic and diastolic BP results had a mean of 139.83.8 mm Hg/89.43 mm Hg and 140.11/89.90 mm Hg, respectively, for males, and 139.32/88.58 mm Hg for females.See Figure 1 for Details.

Factors associated with hypertension

Bivariate analysis:The socio-demographic and Co-morbidities factors with Hypertension

The Kicukiro district residents had statistically significant odds 2.4 times higher of developing HTN compared to those residing in Gasabo (COR: 2.441, 95% C. I= 1.182-5.042).Pensioners using CBHI had 57.6% lower odds of developing hypertension (COR: 0.424, 95% C.I=0.214-0.840) compared to pensioners who had used RAMA and MMI. Participants with a BMI of 25 kg/m² or higher had 1.9 times greater odds of hypertension compared to those with a normal BMI (COR: 1.988, 95% CI = 1.127-3.506). Those employed in central and local government had 3.09 times greater odds of developing hypertension (COR: 3.098, 95% CI = 1.354-7.088) compared to those who had worked in health services. Respondents with HIV/AIDS had 9.47 times higher odds of developing hypertension (COR: 9.473, 95% C.I = 2.140-41.935) compared to those without HIV/AIDS. Respondents with high blood glucose levels had 15 times higher odds of developing hypertension (COR: 15, 95% C.I = 1.945-115.67) compared to pensioners without diabetes mellitus. See Table3 for Details.

Bivariate analysis: Behaviors and Occupation related stress factors with hypertension.

Respondents who used tobacco products had 2.29 times greater odds of developing hypertension (COR: 2.293, 95% C.I = 1.33-3.952) compared to those who did not use tobacco products. Similarly, respondents who consumed alcohol had 2.65 times greater odds of developing hypertension (COR: 2.658, 95% C.I = 1.253-5.638) compared to those who abstained from alcohol. Additionally, respondents who worked under stressful conditions had 11.4 times greater odds of developing hypertension (COR: 11.494, 95% C.I = 3.389-38.973) compared to those who worked in less stressful conditions. Among those who experienced work-related stress, respondents with occasional stress had 3.8 times greater odds of hypertension (COR: 3.857, 95% C.I = 1.952-7.619), while those facing frequent stress at work had 45 times greater odds of developing hypertension (COR: 45, 95% C.I = 9.589-211.17) compared to those who did not experience workplace stress.See table 4 for details.

Multivariate Analysis of Factors Associated with Hypertension among Retirees

The researchers performed a multivariate regression analysis to identify factors associated with hypertension among retirees. After excluding non-significant variables, the analysis identified three factors that independently correlate with hypertension. Retirees with HIV/AIDS have 18.4 times greater odds of developing hypertension (adjusted OR: 18.405, 95% CI = 3.228-104.93) compared to those without HIV/AIDS. Retirees with diabetes mellitus (DM) have 16.8 times greater odds of developing hypertension (adjusted OR: 16.873, 95% CI = 1.591-178.84) compared to those without diabetes mellitus.

Moreover, retirees who experience occasional work-related stress have 2.9 times greater odds of developing hypertension (adjusted OR: 2.902, 95% CI = 1.200-7.021) compared to those who do not experience stress. In contrast, retirees who frequently encounter stress at work have 13.5 times greater odds of developing hypertension (adjusted OR: 13.514, 95% CI = 1.200-7.021) compared to those who do not experience stress. See Table 5 for Details.

The study sought to evaluate the frequency and factors related to hypertension among pensioners in three districts of Kigali City. The research included 220 participants, of whom 64.5% were male and 35.5% were female, with 44% living in the Nyarugenge district. The majority (63.6%) had attained a secondary level of education, and 88.2% were legally married. Pensioners from local and central government comprised the highest proportion of occupations (46.82%). The study observed prevalence rates of 9.09% for HIV/AIDS and 17.27% for diabetes mellitus among respondents.Moreover, 56.36% reported a history of tobacco consumption, while 12.39% admitted to consuming tobacco products during the survey. Additionally, 83.64% acknowledged consuming alcohol in the past. The study discovered that 66.36% of participants had a BMI ≥ 25kg/m2, and 15% had worked in stressful conditions.The prevalence of hypertension among pensioners stood at 53.18%, with higher odds observed among respondents residing in Kicukiro district and those with a BMI ≥ 25kg/m2. Pensioners utilizing CBHI experienced lower odds of developing hypertension compared to those using RAMA and MMI. Other factors associated with higher odds of hypertension included HIV/AIDS, elevated blood glucose levels, tobacco and alcohol consumption, and exposure to stressful working conditions.

Multivariate regression analysis showed that HIV/AIDS, diabetes mellitus, and intermittent or frequent work-related stress are independently linked to hypertension among retirees. Individuals with HIV/AIDS and diabetes mellitus had notably higher odds of developing hypertension, as did those experiencing intermittent or frequent stress at work.

The study revealed a higher prevalence of hypertension in Kigali City, reaching 53.18%, compared to earlier studies on older adults nationwide, which indicated a prevalence of 43.2% in the Non-Communicable Diseases Risk Factors Report 2022.[11] The high prevalence may attribute the hypertension-related age and behavior factors among sampled people. The study also discovers a higher prevalence of hypertension among males (65.81%), contrasting with previous reports on Non-Communicable Diseases, where half of cases were in females aged 60–69. This difference remains consistent with previous studies in Brazil and Argentina, which report higher prevalence. [11, 13, 17]

The study reported that secondary school students constituted the highest prevalence of hypertension, representing 55% of respondents, followed by tertiary students at 33.33%, and primary students at 8.55%. In Ethiopia, the research found that the rate of hypertension among postgraduates was 54%, whereas individuals with a university degree comprised 17.6%. [19] In Bangladesh and India, higher educational levels link to increased hypertension risk, contradicting research in developed nations, which suggests a higher hypertension risk among less educated groups. [26]

A significant number of respondents in local and central government exhibited a high prevalence of hypertension at 46.82%, followed by teachers in education at 27.73%, employees in the health service sector at 14.09%, and other employees at 11.36%. In Nigeria, civil services employees and those in the trading sector constituted 61.7% of the hypertension population, which was high compared to the current study.

[21] Currently, tobacco products are being consumed by 12.39% of respondents, with 100% using manufactured cigarettes. Tobacco products have been used in their lifetime by 56.36% of respondents. Among respondents, 29.9% of females are alcohol consumers, while 70.1% are males. The Rwanda NCDs risk factors report indicates that tobacco smokers comprise 19.1% of men and 7.1% of women, while alcohol has been consumed by 55.3% of respondents, with 65% being males and 46.7% females. [12] The recent Rwandan population's behavior exposes them to factors contributing to hypertension as a disease. These factors may be attributed to the differences.

Retirees often use alcohol to cope with retirement pressures, leading to increased alcohol consumption and drinking issues, ultimately resulting in high blood pressure, as the study revealed. People with diabetes mellitus and HIV/AIDS, combined with occupational stress, were more likely to develop hypertension (HTN) compared to those without these conditions, with prevalence rates of 12.82% and 15.93%, respectively, according to the study. [25] A recent study conducted in CHUK revealed that hypertension had the highest prevalence (22%) among adults living with HIV. Researchers in Japan and Bangladesh demonstrated how healthcare professionals experience moderate stress at work, while their staff experiences less stress. This stress is ascribed to elements such as working extra hours, managing a substantial workload, encountering time pressures, tackling difficult or intricate tasks, neglecting sufficient breaks, enduring monotony, and sustaining inadequate physical health. [14, 26] Occupational stress might lead to the onset of hypertension and requires strategies to mitigate its impact in the work environment.

Strengths and limitations

The study involved 220 participants, ensuring a substantial sample size. This large sample size improves the reliability and generalizability of the findings. Participants were selected from three different districts within Kigali City. This captures a diverse range of socio-economic and demographic backgrounds. It enhances the representativeness of the findings to the larger population of pensioners in the city. A cross-sectional study design was used. It enables the examination of data at a specific moment. This offers valuable insights into the present condition of the population. The study examines various factors associated with hypertension. These include demographic characteristics, lifestyle behaviors, medical history, and occupational factors. This comprehensive approach enhances understanding of the complex interplay between determinants of hypertension. The findings are compared with previous research on hypertension prevalence and risk factors. Both national and international comparisons are made.

Multivariate regression analysis is employed. It identifies independent factors associated with hypertension among pensioners. This controls for potential confounding variables and strengthens the validity of the results. Specific risk factors associated with hypertension among pensioners are identified. This contributes valuable information for the development of targeted interventions and healthcare policies.

The study was not designed to establish causality. It identifies factors associated with hypertension among pensioners. It cannot definitively determine whether these factors directly cause hypertension or are merely correlated with it. The findings may lack generalizability beyond the three districts of Kigali city. Hypertension prevalence among pensioners can vary significantly based on geographic and demographic factors. This suggests the need for a countrywide study to capture broader trends and variations.

The study reveals that hypertension affects 117 (53.18%) pensioners in Kigali City, with HIV/AIDS, diabetes mellitus, and workplace stress significantly predicting its occurrence. To decrease hypertension prevalence, HIV prevention campaigns, workplace screening, stress management education, regular exercise, and lifestyle modifications are necessary to prevent type II diabetes.

The researcher advocates for the Rwandan Ministry of Health to implement public education and mass campaigns for HIV prevention, including high blood pressure screening, to thwart hypertension among the population pre-retirement. It also proposes mobilizing pensioners for physical activity, promoting health education, and curtailing alcohol intake to prevent type II diabetes. The Rwandan government should furnish social protection for NCDs, including hypertension, and champion sustainable community programs to encourage smoking cessation, mitigate work-related stress among employees, facilitate weight loss, and encourage lifestyle modifications.

Declaration of Conflict of Interest

The authors declare that there are no conflicts of interest regarding this research and the authorship of this article.

Funding

No financial support was received for this research.

Author Contribution

P. N. designed the study, collected, examined, and analyzed the data, and then drafted the manuscript. A. N. and J. M. oversaw the research, assisted with data analysis, contributed to manuscript writing, and offered constructive feedback on the manuscript. All authors reviewed and approved the manuscript for publication.

Acknowledgement

The author express their gratitude to the University-College of Medicine and Health Sciences for permitting the study to be conducted. Additionally, they extend their thanks to all research assistants including Dr MUKAMURIGO Judith and Mr NDAGIJIMANA Albert with Priest NSABANZIMA Emmanuel and participants for their time during data collection.

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Table 1. Socio-demographic and Co-morbidities characteristics of participants (n=220).

Variable	Frequency(n)	Percentage (%)
Names of residence
Gasabo	61	27.73
Kicukiro	62	28.18
Nyarugenge	97	44.09
Gender
Male	142	64.55
Female	78	35.45
Age (years)
62-70	114	51.82
71-83	106	48.18
Health insurance
RAMA and MMI	176	80
CBHI	44	20
Educational level
Primary or less	16	7.27
Secondary	140	63.64
Tertiary	64	29.09
Occupation
Health services	31	14.09
Local and central government	103	46.82
Teaching	61	27.73
Others	25	11.36
Marital status
Current married	194	88.18
Divorced /widowed	26	11.82
Pensioners salaried per month /wealth index
<100,000	44	20
100000 and above	176	80
Diabetes Mellitus
Normal	204	92.73
High glucose	16	7.27
HIV/AIDS
Positive	20	9.09
Negative	200	90.91

Table 2. Behavioral characteristics and Occupational stress related factors of participants (n=220).

Variables	Frequency(n)	Percentage (%)
BMI status
Normal	74	33.64
Abnormal	146	66.36
History of tobacco consummation
Yes	124	56.36
No	96	43.64
Current smoker
Yes	27	12.39
No	193	87.73
History of alcohol drunk
Yes	184	83.64
No	36	16.36
Current drunker
Yes	83	37.73
No	137	62.27
Number of days ate fruits per week
0 -2days	91	41.36
3 -5 days	112	50.91
6 – 7 days	17	7.73
Number of days ate vegetables per week
0 – 2 days	9	4.09
3 -5 days	139	63.18
6 -7 days	72	32.73
Physical activity
Yes	52	23.64
No	168	76
Ever worked in stressful condition
Yes	33	15
No	187	85
Ever had stress at work
Sometimes	128	58.18
Several times	32	14.55
Never	60	27.27

Table 3.Bivariate analysis for the socio-demographic and Co-morbidities factors to hypertension (n=220).

Variables	HTN n (%)	Non-HTN n(%)	OR	95 %C.I)	P-value
Gender
Male	77(65.81)	65(63.11)	(Ref)
Female	40(34.19)	38(36.89)	0.88	0.510-1.545	0.676
Residences
Gasabo	25(21.37)	36(34.95)	(Ref)
Kicukiro	39(33.33)	23(22.33)	2.282	1.107-4.704	0.025
Nyarugenge	53(45.30)	44(42.72)	1.555	0.815-2.966	0.180
Health insurance
RAMA &MMI	101(86.32)	75(72.82)	(Ref)
CBHI	16(13.68)	28(27.18)	0.424	0.214-0.840	0.014
Age (years)
62-70	59(50.43)	55(53.40)	(Ref)
71-83	58(49.57)	48(46.60)	1.126	0.662-1.914	0.660
Level of education
Primary	8(6.84)	8(7.77)	(Ref)
Secondary	70(59.83)	70(67.96)	1	0.355-2.813	1.000
Tertiary	39(33.33)	25(24.27)	1.56	0.518-4.691	0.429
Occupation
Health services	14(11.97)	17(16.50)	( Ref)
Local and central government	74(63.25)	29(28.16)	3.098	1.354-7.088	0.007
Teaching	18(15.38)	43(41.75)	0.508	0.207-1.245	0.139
Others..	11(9.40)	14(13.59)	0.954	0.330-2.754	0.931
Marital status
Current married	103(88.03)	91(88.35)	(Ref)
Divorced/Widowed	14(11.97)	12(11.65)	1.030	0.453-2.342	0.942
Pensioners salaries/wealth index
<100,000	18(15.38)	26(25.24)	( Ref)
100000 and above	99(84.62)	77(74.76)	1.857	0.949-3.631	0.230
BMI status
Normal	31(26.50)	43(41.75)	(Ref)
Abnormal	86(73.50)	60(58.25)	1.988	1.127-3.506	0.018
HIV/AIDS
Negative	95(84.07)	100(98.04)	(Ref)
Positive	18(15.93)	2(1.96)	9.473	2.140-41.935	0.003
DM
Normal	102(87.18)	102(99.03)	(Ref)
High glucose	15(12.82)	1(0.97)	15	1.945-115.67	0.009

Table 4.Bivariate analysis for behavioral and Occupation related stress factors and hypertension (n=220).

Variables	HTN n(%)	Non-HTN n(%)	OR	95 %C.I)	P-value
History of tobacco consumption
No	40(34.19)	56(54.37)	(Ref)
Yes	77(65.81)	47(45.63)	2.293	1.330-3.952	0.003
Current smoker
No	98(83.76)	93(92.08)	(Ref)
Yes	19(16.24)	8(7.92)	2.253	0.941-5.398	0.068
History of alcohol drunker
No	12(10.26)	24(23.30)	(Ref)
Yes	105(89.74)	79(76.70)	2.658	1.253-5.638	0.011
Current alcohol drunker
No	68(58.12)	69(66.99)	(Ref)
Yes	49(41.88)	34(33.01)	1.462	0.842-2.537	0.176
Number of days ate vegetables per week
6 - 7 days	6(5.13)	11(10.68)	(Ref)
0 – 2 days	54(46.15)	37(35.92)	2.675	0.909-7.871	0.074
3 -5 days	57(48.72)	55(53.40)	1.9	0.657-5.492	0.236
Number of vegetable servings per days
Twice or 3 times	2(1.71)	1(0.97)	(Ref)
Never or once.	115(98.29)	102(99.03)	0.563	0.050-6.309	0.642
Number of days ate fruits per week
6 - 7 days	6(5.13)	11(10.68)	(Ref)
0 – 2 days	54(46.15)	37(35.92)	2.675	0.909-7.871	0.074
3 -5 days	57(48.72)	55(53.40)	1.9	0.657-5.492	0.236
Number of fruits servings per days
Never or once	115(98.29)	102(99.03)
Twice or 3 times	2(1.71)	1(0.97)	1.77	0.158-19.853	0.642
Physical activity
No	91(77.78)	77(74.76)	(Ref)
Yes	26(22.22)	26(25.24)	0.0.936	0.502-1.744	0.835
Ever worked in stressful condition
No	87(74.36)	100(97.09)	(Ref)
Yes	30(25.64)	3(2.91)	11.494	3.389-38.973	<0.001
Times had stress at work
Never	15(12.27)	45(43.69)	(Ref)
sometimes	72(61.54)	56(54.37)	3.857	1.952-7.619	<0.001
Several times	30(25.64)	2(1.94)	45	9.589-211.17	<0.001

Table 5. Multivariate Analysis for factors predictors of hypertension among pensioners..

Variables	HTN n (%)	Non-HTN n (%).	AOR	95 %C.I)	P-value
HIV/AIDS
Negative	95(84.07)	100(98.04)	(Ref)
Positive	18(15.93)	2(1.96)	18.405	3.228-104.93	0.001
DM
Normal	102(87.18)	102(99.03)	(Ref)
High glucose	15(12.82)	1(0.97)	16.873	1.591-178.84	0.019
Ever worked in stressful condition
No	87(74.36)	100(97.09)	(Ref)
Yes	30(25.64)	3(2.91)	3.796	0.805-17.897	0.092
Times had stress at work
Never	15(12.27)	45(43.69)	(Ref)
sometimes	72(61.54)	56(54.37)	2.902	1.2000-7.021	0.018
Several times	30(25.64)	2(1.94)	13.514	2.205-82.825	0.005

No competing interests reported.

Prevalence and Determinants of Hypertension among pensioners in Three Districts of Kigali City, Rwanda, 2023: A Cross-Sectional Study

Status:

Version 1

Abstract

Background

Objective

Methods

Results

Conclusion

Figures

Introduction

Methods

Study Design and Setting

Study Population and eligibility criteria

Sample size and sampling procedures

Data processing, study variables and analysis

Ethical consideration

Results

Description of socio-demographic and Co-morbidities characteristics of participants.

Pensioners behavioral characteristics and Occupational stress related factors

Factors associated with hypertension

Bivariate analysis:The socio-demographic and Co-morbidities factors with Hypertension

Bivariate analysis: Behaviors and Occupation related stress factors with hypertension.

DISCUSSION

Strengths and limitations

Conclusions and Recommendations

Declarations

Declaration of Conflict of Interest

Funding

Author Contribution

Acknowledgement

References

Tables

Additional Declarations

Status:

Version 1