Association of anaemia with indoor air pollution among older Indian adult population: multilevel modelling analysis of nationally representative cross-sectional study.

INTRODUCTION: Anaemia is a disease of public health importance with multi-causal pathways. Previous literature suggests the role of indoor air pollution (IAP) on haemoglobin levels, but this has been studied less due to logistic constraints. A high proportion of the population in developing countries, including India, still depends on unclean fuel, which exacerbates IAP. The objective was to study the association between anaemia and IAP among the older Indian adult population (≥ 45 years) as per gender. METHODS: Our study analysed the nationally representative dataset of the Longitudinal Ageing Study in India (LASI 2017-18, Wave-1). We have documented the association of anaemia (outcome variable) with IAP (explanatory variable). To reduce the confounding effects of demographic and socioeconomic; health related and behavioural covariates; propensity score matching (PSM) was conducted. Nested multilevel regression modelling was conducted. States and union territories were categorised cross tabulated as low, middle and high as per anaemia and IAP exposure. P value < 0.05 was considered statistically significant. SATA version 17 was used for analysis. RESULTS: More than half (52.52%) of the participants were exposed to IAP (male (53.55%) > female (51.63%)). The odds of having anaemia was significantly 1.19 times higher (AOR 1.19 (1.09-1.31)) among participants using unclean/ solid fuel. The adjusted odds were significantly higher among participants exposed to pollution-generating sources (AOR 1.30; 1.18-1.43), and household indoor smoking (AOR 1.17 (1.07-1.29). The odds of having anaemia were significantly higher (AOR 1.26; 1.15-1.38) among participants exposed to IAP, which was higher in males (AOR 1.36; 1.15-1.61) than females (AOR 1.21; 1.08-1.35). Empowered Action Group (EAG) states like Uttar Pradesh, Chhattisgarh, Madhya Pradesh, Bihar had both high anaemia and IAP exposure. CONCLUSION: This study established the positive association of anaemia with indoor air pollution among older Indian adults through a nationally representative large dataset. The association was higher among men. Further research is recommended to understand detailed causation and to establish temporality. It is a high time to implement positive intervention nationally to decrease solid/ unclean fuel usage, vulnerable ventilation, indoor smoking, IAP and health hazards associated with these with more focused actions towards EAG states.

Cardiovascular risk assessment using non-laboratory based WHO CVD risk prediction chart with respect to hypertension status among older Indian adults: insights from nationally representative survey.

Introduction: Knowledge of the risk of developing cardiovascular diseases (CVD) in the population is an important risk management strategy for the prevention of this disease. This is especially true for India, which has resource-restrained settings with an increased risk in a younger population for the development of the disease. An important modifiable risk factor for CVD is hypertension, with its influence on the development of CVD. Methods: The data from the first wave of the Longitudinal Ageing Study in India (LASI) was used to calculate the 10-year CVD Risk Score among older adults ≥45 years using a WHO (2019) non-laboratory- based chart for South Asia. Univariate analysis was done using Pearson's chi-square test, and multivariable analysis using ordinal logistic regression. Categories of CVD risk score were considered as dependent variable. Socio-demographic variables, regular exercise, history of diabetes and hyperlipidaemia were considered as the independent variables. Relationship between CVD Risk score and hypertensives and self-reported hypertensives were presented using restricted cubic splines. Result: Two-thirds (68.8%) of the population had a 10-year CVD risk of <10, and 2.8% had a risk of ≥20%. The self-reported hypertensives were distributed linearly in restricted cubic splines, with a more scattered distribution in higher scores, while actual hypertensives showed a sigmoid pattern. Urban residents (OR-0.88), being unmarried (OR-0.86), being in the richer (OR-0.94) and richest (OR-0.86) monthly per capita expenditure (MPCE) quintile and exercising regularly (OR-0.68) decreased the odds of being in a higher CVD risk score. Less than primary schooling (1.21) and diabetics (1.69) had higher odds for a higher CVD risk score. Conclusion: In this population, two-thirds had <10% risk for the development of CVD. The study shows a higher risk among rural, poor, and those with a lower education and lower CVD risk for those undertaking physical activity. The sigmoid pattern in actual hypertensives highlights the need for early detection. Even those with undiagnosed hypertension but with a higher BP had a similar risk for disease development, thus highlighting the need for an early detection of hypertension.

Association of Benign Prostatic Hyperplasia With Multimorbidity Among Older Adults: Insights From the Longitudinal Ageing Study in India (LASI), First Wave.

Introduction Population ageing is expected to be accompanied by an increase in multi-morbidity, i.e. the co-occurrence of multiple chronic conditions simultaneously. Benign prostatic hyperplasia (BPH) is a non-malignant disease prevalent in ageing men. Both BPH and multi-morbidity are known to have a significant impact on quality of life. The objective of this study was to determine the association between BPH and multimorbidity among older adults and the elderly population in India. Methods This is an analytical cross-sectional study involving secondary data from the nationally representative Longitudinal Ageing Study in India (LASI) Wave I 2017-18. Multivariable logistic regression analysis was conducted to study the association between BPH and multimorbidity while accounting for other associated factors. Results Compared to those having no co-morbidities, the odds of having BPH increased with the increasing number of co-morbidities. Those with at least two co-morbidities were twice as likely (aOR=2.19; 95%CI 1.78-2.72), and those with at least four co-morbidities were almost six times as likely (aOR=5.78; 95%CI 2-16.72) to have BPH as compared to those with no co-morbidities. The association was stronger among males >60 years. Conclusion Self-reported benign prostatic hyperplasia was found to be strongly associated with multi-morbidity. The need of the hour is the inclusion of BPH within the framework of a national health programme. Health technology assessment of high-risk screening strategies for BPH may be conducted among patients with multimorbidity. Research into the impact on the quality of life of those affected by both BPH and multimorbidity will help highlight this as a priority problem for decision-makers.