Ecological Study of HIV Infection and Hypertension in Sub-Saharan Africa: Is There a Double Burden of Disease?

Clicks: 1077
ID: 17815
2016
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Article Quality & Performance Metrics
Overall Quality Improving Quality
81.8 /100
Combines engagement data with AI-assessed academic quality
AI Quality Assessment 🥈 High Quality
82.0 /100
Academic Rigor 88.0%
Novelty 70.0%
Clarity 85.0%
Key Strengths
  • Robust statistical analysis
  • Clear presentation of results
  • Relevant and timely research question
Areas for Improvement
  • Ecological study design limits causal inference
  • Potential for ecological fallacy
  • Reliance on secondary data sources
AI Recommendations

The authors should acknowledge the limitations of the ecological study design more explicitly. Further discussion on the potential mechanisms linking HIV and hypertension would strengthen the paper. Consider exploring heterogeneity in the relationship across different sub-Saharan African countries.

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Abstract
METHODS:Data on prevalence of hypertension were derived from a systematic search of literature published between 1975 and 2014 with corresponding national estimates on HIV prevalence and antiretroviral therapy (ART) coverage from the Demographic and Health Surveys and the joint United Nations Programme on HIV/AIDS databases. National estimates on gross national income (GNI) and under-five mortality were obtained from the World Bank database. Linear regression analyses using robust standard errors (allowing for clustering at country level) were carried out for associations of age-standardised hypertension prevalence ratios (standardized to rural Uganda's hypertension prevalence data) with HIV prevalence, adjusted for national indicators, year of study and sex of the study population. RESULTS:In total, 140 estimates of prevalence of hypertension representing 25 nations were sex-and area-matched with corresponding HIV prevalence. A two-fold increase in HIV prevalence was associated with a 9.29% increase in age, sex and study year-adjusted prevalence ratio for hypertension (95% CI 2.0 to 16.5, p = 0.01), which increased to 16.3% (95% CI 9.3 to 21.1) after adjusting for under-five mortality, GNI per capita and ART coverage. CONCLUSIONS:Countries with a pronounced burden of HIV may also have an increased burden of non-communicable diseases such as hypertension with potential economic and health systems implications.
Reference Key
angkurawaranon2016ecologicalplos Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Angkurawaranon, C;Nitsch, D;Larke, N;Rehman, A M;Smeeth, L;Addo, J;
Journal PloS one
Year 2016
DOI
10.1371/journal.pone.0166375
URL
http://europepmc.org/articles/PMC5113946?pdf=render
Keywords
hiv infection hypertension sub-saharan africa Epidemiology Double burden of disease linear regression antiretroviral therapy Ecological study

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