Investigating associations between rural-to-urban migration and cardiometabolic disease in Malawi: a population-level study

Chilunga, F. P., Musicha, C., Tafatatha, T., Geis, S., Nyirenda, M. J., Crampin, A. and Price, A. J. (2019) Investigating associations between rural-to-urban migration and cardiometabolic disease in Malawi: a population-level study. International Journal of Epidemiology, 48(6), pp. 1850-1862. (doi: 10.1093/ije/dyz198) (PMID:31603469) (PMCID:PMC6929524)

Abstract

Background: The extent to which rural-to-urban migration affects risk for cardiometabolic diseases (CMD) in Africa is not well understood. We investigated prevalence and risk for obesity, diabetes, hypertension and precursor conditions by migration status. Methods: In a cross-sectional survey in Malawi (February 2013–March 2017), 13 903 rural, 9929 rural-to-urban migrant and 6741 urban residents (≥18 years old) participated. We interviewed participants, measured blood pressure and collected anthropometric data and fasting blood samples to estimate population prevalences and odds ratios, using negative binomial regression, for CMD, by migration status. In a sub-cohort of 131 rural–urban siblings-sets, migration-associated CMD risk was explored using conditional Poisson regression. Results: In rural, rural-to-urban migrant and urban residents, prevalence estimates were; 8.9, 20.9 and 15.2% in men and 25.4, 43.9 and 39.3% in women for overweight/obesity; 1.4, 2.9 and 1.9% in men and 1.5, 2.8 and 1.7% in women for diabetes; and 13.4, 18.8 and 12.2% in men and 13.7, 15.8 and 10.2% in women for hypertension. Rural-to-urban migrants had the greatest risk for hypertension (adjusted relative risk for men 1.18; 95% confidence interval 1.04–1.34 and women 1.17: 95% confidence interval 1.05–1.29) and were the most screened, diagnosed and treated for CMD, compared with urban residents. Within sibling sets, rural-to-urban migrant siblings had a higher risk for overweight and pre-hypertension, with no evidence for differences by duration of stay. Conclusions: Rural-to-urban migration is associated with increased CMD risk in Malawi. In a poor country experiencing rapid urbanization, interventions for the prevention and management of CMD, which reach migrant populations, are needed.

• Item Type: Articles
• Additional Information: Funding: This work was supported by the Wellcome Trust (098610/Z/12/Z).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Crampin, Professor Mia
• Authors: Chilunga, F. P., Musicha, C., Tafatatha, T., Geis, S., Nyirenda, M. J., Crampin, A., and Price, A. J.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: International Journal of Epidemiology
• Publisher: Oxford University Press
• ISSN: 0300-5771
• ISSN (Online): 1464-3685
• Published Online: 12 October 2019
• Copyright Holders: Copyright © The Author(s) 2019
• First Published: First published in International Journal of Epidemiology 48(6):1850-1862
• Publisher Policy: Reproduced under a Creative Commons license