Prevalence of selected risk factors for chronic disease—Jordan, 2002

Morbidity and Mortality Weekly Report, Oct 31, 2003 by F Shehab, A Belbeisi, H Walke

In Jordan, the average life expectancy in 2002 was 72 years (1), and chronic diseases are becoming increasingly prevalent (2-4). Because personal behavior can influence the occurrence and progression of many chronic diseases, the Jordan Ministry of Health (JMoH) established surveillance for behavioral risk factors, particularly those related to cardiovascular diseases and diabetes. This report summarizes the key findings of the 2002 Behavioral Risk Factor Survey, the first reporting segment in Jordan's surveillance program for chronic diseases. The findings indicate that smoking, physical inactivity, and obesity contribute substantially to the burden of chronic disease in Jordan and underscores the need for effective public health interventions.

In May 2002, a total of 28 questions about behavioral risk factors and noncommunicable disease prevalence were added to the Jordan Department of Statistics' quarterly, multistage, cross-sectional employment and unemployment survey. The sample was based on the sampling frame provided by the 1994 Jordan Population and Housing Census. The frame excluded persons living in remote areas, the majority of whom are nomads, and those living in collective dwellings (e.g., hotels, hospitals, work camps, and prisons). The sampling frame was representative nationally and stratified by governorate, major city, and other urban and rural areas. Within each stratum, sample blocks were selected systematically with probability proportional to size, and sample households were selected by using a systematic random procedure. One respondent aged [greater than or equal to] 18 years was selected from each sample household and interviewed directly. All reported estimates were weighted to account for the sample design and were further adjusted for the noninterview response rate. STATA-7 software (5) was used to calculate 95% confidence intervals.

Respondents were asked whether they ever had their blood pressure or cholesterol checked by a health-care professional and whether a health-care professional had ever told them that they had high blood pressure, high cholesterol, asthma, or diabetes or that they had had a heart attack. Gestational diabetes was excluded from the analysis. Smokers were classified as "ever smokers" (i.e., smokers who had smoked [greater than or equal to] 100 cigarettes during their lifetime) or "current smokers" (i.e., smokers who had ever smoked 100 cigarettes and currently smoke every day or some days). Questions on self-reported height and weight were included, and body mass index (BMI) (i.e., ratio of weight in kilograms to height in meters squared [kg/[m.sup.2]]) was calculated. Being overweight was classified as having a BMI of 25.0-25.9, and obesity was classified as having a BMI of [greater than or equal to] 30. Respondents were asked whether they engaged in weekly moderate or vigorous activity. Moderate activity was defined as any activity that caused light sweating and small increases in heart rate or breathing for 30 minutes. Vigorous activity was defined as any activity that caused heavy sweating or large increases in heart rate or breathing for 20 minutes. Respondents also were asked when they had last sought health care from a health-care professional.

A total of 8,791 questionnaires were completed among 9,601 sampled households (response rate: 92%), excluding vacant and closed houses. The prevalence of persons who had ever had their blood pressure checked was 67% (74% of women and 61% of men) (Table). Of 6,147 respondents who ever had their blood pressure checked, 22% had been told by a health-care professional that they had high blood pressure. A total of 19% of respondents reported ever having had their blood cholesterol checked; however, this prevalence was 35% among respondents aged 50-64 years. The overall reported prevalence of diabetes was 6%; however, this prevalence increased to 20% for persons aged 50-64 years. The reported prevalence of asthma was 5% (6% of women and 4% of men), and 2% of respondents had ever been told by a health-care professional that they had had a heart attack. A total of 30% of respondents reported currently smoking cigarettes every day or some days, and 38% reported ever smoking [greater than or equal to] 100 cigarettes. Nearly half (51%) of the male respondents were current smokers, compared with 8% of female respondents. Among current smokers, men smoked approximately 23 cigarettes per day, compared with 12 cigarettes a day among women. Among current smokers who had visited a healthcare professional during the preceding 6 months, 43% had received counseling about smoking. The prevalence of being overweight was 32%, and the prevalence of obesity was 13% (16% of women and 10% of men). Among obese respondents who visited a health-care professional during the preceding 6 months, 26% received counseling about exercise and 34% about nutrition. The prevalence of any weekly vigorous physical activity was 32%, and 53% of all respondents reported weekly physical activity.