The document summarizes findings from the Saudi Health Interview Survey (SHIS) conducted in 2013. Some key findings include:
- 15.1% of Saudis ages 15 or older are hypertensive, 40.5% are borderline hypertensive
- 8.5% are hypercholesterolemic and 20% are borderline hypercholesterolemic
- 13.4% are diabetic and 16.3% are borderline diabetic
- 28.7% of Saudis are obese
Unit I herbs as raw materials, biodynamic agriculture.ppt
Chronic diseases and their risk factors in the Kingdom of Saudi Arabia
1. Chronic diseases and their risk factors in
the Kingdom of Saudi Arabia
October 15, 2014
Ali H. Mokdad, PhD
Director of Middle Eastern Initiatives
Professor of Global Health
2. Outline
Changing burden of disease in the Kingdom of
Saudi Arabia
Saudi Health Interview Survey (SHIS)
• Weighting methodology
• Summary of findings
• Chronic health problems
• Risk factors and health behaviors
• Conclusions and recommendations
• Dissemination of findings
Next steps
2
10. Outline
Changing burden of disease in the Kingdom of
Saudi Arabia
Saudi Health Interview Survey (SHIS)
• Weighting methodology
• Summary of findings
• Chronic health problems
• Risk factors and health behaviors
• Conclusions and recommendations
• Dissemination of findings
Next steps
10
11. Saudi Health Interview Survey (SHIS)
• Combines a health questionnaire with anthropometric
measures and blood sample analysis
• Computer-assisted personal interviewing with near real-time
data monitoring
• Survey conducted by ~240 interviewers (358 total personnel)
from April to June 2013
• All adults were administered a questionnaire and invited to visit
a clinic for further measurements
11
12. Sample design
• Multistage representative sample of Saudi households
• Conducted in all regions using probability proportional to size
• Total sample size 12,000 households
• Selection of a random adult 15 years of age or older
12
13. Survey tools
• Household interview
− Household roster
− Random adult selection
− Socioeconomic information
− Health behavior
− Access to and utilization of
health care
− History of chronic conditions
− Health problems
− Anthropometry
− Blood pressure
• Blood draw and analysis
at local clinic
− Blood glucose (HbA1c)
− Blood lipid profile (HDL, LDL,
TRIG)
− Vitamin D
13
14. Response rate to household interview
• 12,000 households contacted
• 10,735 respondents completed the household interview
o Response rate of 89.5%
14
15. SHIS age and sex distribution
Age Sex Sample percent Census 2013
15 - 24 Males 11.08 15.77
Females 11.11 15.39
25 - 34 Males 11.68 12.81
Females 14.00 12.67
35 - 44 Males 10.54 9.31
Females 11.24 9.25
45 - 54 Males 6.73 6.20
Females 7.43 6.05
55 - 64 Males 4.09 3.58
Females 3.94 3.48
65+ Males 4.82 2.73
Females 3.33 2.76
15+ Males 48.93 50.40
Females 51.07 49.60
Total 100.00 100.00
15
16. Outline
Changing burden of disease in the Kingdom of
Saudi Arabia
Saudi Health Interview Survey (SHIS)
• Weighting methodology
• Summary of findings
• Chronic health problems
• Risk factors and health behaviors
• Conclusions and recommendations
• Dissemination of findings
Next steps
16
17. Household interview weight: WHI
• Two steps
o Probability of selection
─ 𝐩 𝐬𝐞𝐥𝐞𝐜𝐭𝐢𝐨𝐧 =
𝐍 𝐡𝐨𝐮𝐬𝐞𝐡𝐨𝐥𝐝𝐬,𝐬𝐚𝐦𝐩𝐥𝐞𝐝,𝐫𝐞𝐠𝐢𝐨𝐧
𝐍 𝐡𝐨𝐮𝐬𝐞𝐡𝐨𝐥𝐝𝐬,𝐭𝐨𝐭𝐚𝐥,𝐫𝐞𝐠𝐢𝐨𝐧 ∗ 𝐍𝐢𝐧𝐝𝐢𝐯𝐢𝐝𝐮𝐚𝐥𝐬,𝐭𝐨𝐭𝐚𝐥,𝐡𝐨𝐮𝐬𝐞𝐡𝐨𝐥𝐝
─ 𝐰 𝐩𝐞𝐫𝐬𝐨𝐧 =
𝟏
𝐩 𝐬𝐞𝐥𝐞𝐜𝐭𝐢𝐨𝐧
o Post-stratification
─ 𝒘 𝒑𝒆𝒓𝒔𝒐𝒏,𝒑𝒐𝒔𝒕−𝒔𝒕𝒓𝒂𝒕𝒊𝒇𝒊𝒆𝒅 = 𝐰 𝐩𝐞𝐫𝐬𝐨𝐧 ∗
% 𝐩𝐨𝐩 𝐒𝐚𝐮𝐝𝐢,𝐚𝐠𝐞,𝐬𝐞𝐱
% 𝐩𝐨𝐩 𝐬𝐚𝐦𝐩𝐥𝐞,𝐚𝐠𝐞,𝐬𝐞𝐱
WHI
17
19. Response rate to clinic visit
• 10,735 respondents completed the household interview
• 5,590 visited a local clinic for blood analysis
o Response rate of 52.1%
19
20. Predictors of clinical visits following the survey
Participated in the lab exam
Independent variables Categories No % Yes % AO
R
95% CI
Last routine
medical visit
Never 54.1 45.9 REF
Within 2013 54.0 46.0 0.9 0.8 – 1.1
Within 2012 52.0 48.0 1.04 0.8 – 1.3
2005 – 2011 61.6 38.4 0.7 0.6 – 0.9
Smoking status Nonsmoker 52.7 47.3 REF
Smoker 64.9 35.1 0.90 0.8 – 1.0
Self-rated health Excellent/very
good
56.5 43.5 REF
Good 46.9 53.1 1.3 1.2 – 1.5
Fair/poor 45.4 54.6 1.4 1.2 – 1.7
BMI (kg/m2) < 25 57.6 42.4 REF
25.00 – 29.99 55.7 44.3 1.1 0.9 – 1.2
30.00 – 34.99 48.0 52.0 1.4 1.2 – 1.5
≥ 35 44.8 55.2 1.5 1.2 – 2.0
Pre-diabetes
diagnosis
No 56.6 43.4 REF
Yes 40.7 59.3 1.7 1.2 – 2.4
20
23. Conclusions
• Fewer respondents complete a clinic visit following a
household interview
o Respondents present a self-selection bias
• Non-response and self-selection biases lead to over- or
underestimation of national burden of disease
23
24. Lessons learned
• Correcting for non-response and self-selection is possible
o Sample design
─ Probability of selection
o Census information
─ Post-stratification
» Educational level if available
o Respondents’ characteristics
─ Behavioral
─ Health
• Weighting methodology documentation
o Comparability and reliability
24
25. Outline
Changing burden of disease in the Kingdom of
Saudi Arabia
Saudi Health Interview Survey (SHIS)
• Weighting methodology
• Summary of findings
• Chronic health problems
• Risk factors and health behaviors
• Conclusions and recommendations
• Dissemination of findings
Next steps
25
26. Summary of findings for Saudis ages 15 or older
15.1%
are hypertensive
40.5%
are borderline
hypertensive
8.5%
are hypercholesterolemic
20%
are borderline
hypercholesterolemic
13.4%
are diabetic
16.3%
are borderline diabetic
26
27. Summary of findings for Saudis ages 15 or older
28.7%
are obese
51%
are vitamin D deficient
12.2%
currently smoke cigarettes
11.3%
consume shisha daily
75.5%
have never gone for a
routine checkup
27
28. Outline
Changing burden of disease in the Kingdom of
Saudi Arabia
Saudi Health Interview Survey (SHIS)
• Weighting methodology
• Summary of findings
• Chronic health problems
• Risk factors and health behaviors
• Conclusions and recommendations
• Dissemination of findings
Next steps
28
29. Body mass index (BMI)
42.5
33.4
24.1
38.6
28.0
33.5
40.6
30.7
28.7
0
5
10
15
20
25
30
35
40
45
< 25.0 kg/m2 25-<30 30+
%
Males Females Total
29
43. Current status of past pre-diabetics
56.0 54.9
23.3
19.820.7
25.3
0
10
20
30
40
50
60
Males Females
%
Normal PreDiabetic Diabetic
43
44. Current status for diagnosed pre-diabetic by
routine medical checkup
53.2
24.7
22.1
44.6
29.1
26.4
78.4
3.1
18.4
0
10
20
30
40
50
60
70
80
90
100
never this year in the past
%
Normal PreDiabetic Diabetic
44
46. Outline
Changing burden of disease in the Kingdom of
Saudi Arabia
Saudi Health Interview Survey (SHIS)
• Weighting methodology
• Summary of findings
• Chronic health problems
• Risk factors and health behaviors
• Conclusions and recommendations
• Dissemination of findings
Next steps
46
47. Last routine medical checkup
74.8
15.2
6.2
3.8
76.3
14.3
6.2
3.2
75.5
14.8
6.2
3.5
0
10
20
30
40
50
60
70
80
90
100
Never 2013 2012 2 – 6 years ago
%
Males Females Total
47
48. Distance traveled for last routine medical checkup
64.9
18.6
15.6
1.0
55.0
20.4
22.4
2.2
61.0
19.3 18.3
1.4
0
10
20
30
40
50
60
70
within 5 km 5 – 10 km 10 – 50 km 50 – 100 km
%
Males Females Total
48
49. Fruit and vegetable consumption, per day
30.9
33.2
28.7
7.2
32.4 33.0
26.6
8.0
31.6
33.1
27.7
7.6
0
5
10
15
20
25
30
35
< 1 serving 1 – 2 serving 2 – 5 servings 5+ servings
%
Males Females Total
49
50. Smoking status
70.5
6.9
21.5
1.2
97.9
0.6 1.1 0.4
84.0
3.8
11.4
0.8
0
10
20
30
40
50
60
70
80
90
100
Never smoked Ex-smoker Current daily Current non-daily
%
Males Females Total
50
51. Prevalence of daily shisha consumption
20.9
1.4
11.3
19.9
1.1
10.6
0
5
10
15
20
25
Males Females Total
%
Current Current Daily
51
55. Difficulty walking a short distance
86.5
11.7
1.8
75.3
21.4
3.3
81.0
16.5
2.5
0
10
20
30
40
50
60
70
80
90
100
No difficulty Little or some High difficulty or Inability
%
Males Females Total
55
56. Ability to do vigorous activities
71.9
18.0
10.1
57.7
26.5
15.8
65.0
22.1
12.9
0
10
20
30
40
50
60
70
80
Able Very little or somewhat able Inability
%
Males Females Total
56
58. Outline
Changing burden of disease in the Kingdom of
Saudi Arabia
Saudi Health Interview Survey (SHIS)
• Weighting methodology
• Summary of findings
• Chronic health problems
• Risk factors and health behaviors
• Conclusions and recommendations
• Dissemination of findings
Next steps
58
59. Conclusions
1. A young population, hence the burden of NCDs will
increase irrespective of changes in rates.
2. High risk factors such as lack of physical activity, poor
diet, and smoking. Tackling these risk factors should be
a priority.
3. High levels of pre-conditions is a concern.
4. Lack of control of conditions is a concern. Our results
suggest that it is due to personal behaviors rather than
a medical response.
5. Lack of preventive care is alarming in a free and
accessible health care system.
59
60. Outline
Saudi Health Interview Survey
Key findings
Risk factors and health behaviors
Conclusions
Recommendations
Next steps
60
61. Early detection campaigns
1. Encourage individuals to know their numbers
2. Conduct early detection campaigns
3. Get out there and do not wait for them to come to the
clinics (workplace, religious gathering, major events,
etc…).
4. 525,600 and 350,400 rule
There are 525,600 minutes a year; accounting for 8 hrs/day of sleep we
have 350,400 minutes. If a person sees a physician 4 times a year for
30 minutes, this amounts to only 0.03% of his/her time interacting with
the health care system. The rest of the time is spent in one’s
community. Indeed, we need to get out there and reach people to
prevent diseases and improve health.
61
62. Focus on preventable risks
1. Focusing on preventable risks is likely to be more cost-
effective: bigger potential benefits, neglected in many
communities, and less costly than other strategies.
2. Increase in smoking levels and shisha use among
males will have a severe impact on health and should
be a priority in prevention activities
62
63. Strategies on physical activity, diet, and obesity
1. Independent but interrelated risks of total caloric intake,
composition of diet, and physical activity with obesity.
2. Patterns of change suggest optimism on the potential
across the Kingdom to change physical activity.
Changes in composition of diet may also be feasible
through a mixture of promotion, subsidies, and
regulation.
3. Strategies to decrease obesity or address the
imbalance between total energy intake and expenditure
with large-scale population effects are less clear.
Estimated benefits of physical activity and diet
composition are independent of obesity.
63
64. Fund local innovative strategies to reduce risks
1. Given the diversity of risks and communities, no simple
menu of effective programs for risk reduction.
2. Local experimentation to figure out what works in a
given community is likely to be necessary.
3. Fund innovative strategies and document through
independent evaluation whether they work or not.
64
65. Use the power of incentives
1. Reward programs that demonstrate measured changes
in risks in the community they are serving by extending
or increasing funding.
2. Stop funding programs that do not demonstrate
progress on risk reduction.
65
66. Engage medical providers in accountable care
1. With many leading risks (tobacco, blood pressure, blood
sugar, cholesterol, alcohol intake, physical inactivity,
components of diet), there is an important role for primary
health care.
2. Need to broaden the notion of accountability beyond
providing high-quality care to encompass achieving risk
reduction in partnership with patients.
3. Forging a connection between health care provision and
progress for individuals and communities in health outcomes
will be critical for the future.
66
67. Outline
Changing burden of disease in the Kingdom of
Saudi Arabia
Saudi Health Interview Survey (SHIS)
• Weighting methodology
• Summary of findings
• Chronic health problems
• Risk factors and health behaviors
• Conclusions and recommendations
• Dissemination of findings
Next steps
67
69. Dissemination materials
- Adult obesity in the Kingdom of Saudi Arabia at a glance
- Hypercholesterolemia in the Kingdom of Saudi Arabia at a glance
- Diabetes in the Kingdom of Saudi Arabia at a glance
- Hypertension in the Kingdom of Saudi Arabia at a glance
- Smoking in the Kingdom of Saudi Arabia: Findings from the Saudi
Health Interview Survey
- Saudi Health Interview Survey Report of Results
69
70. Publications
Accepted manuscripts as of June 2015:
Burden of Disease, Injuries, and Risk Factors in the Kingdom of Saudi Arabia
1990-2010. Preventing Chronic Disease.
Obesity and associated factors – Kingdom of Saudi Arabia, 2013. Preventing
Chronic Disease.
Hypertension and its associated risk factors in the Kingdom of Saudi Arabia,
2013: a national survey. International Journal of Hypertension.
Hypercholesterolemia and its associated risk factors – Kingdom of Saudi Arabia,
2013. Annals of Epidemiology.
Status of the diabetes epidemic in the Kingdom of Saudi Arabia, 2013.
International Journal of Public Health.
Reported stroke symptoms and their associated risk factors in the Kingdom of
Saudi Arabia, 2013. Journal of Hypertension - Open Access.
70
71. Publications
Accepted manuscripts as of June 2015:
Breast cancer screening in Saudi Arabia: free but almost no takers (PLOS ONE)
Tobacco consumption in the Kingdom of Saudi Arabia, 2013: findings from a national
survey (BMC Public Health)
Fruit and vegetable consumption among adults in Saudi Arabia, 2013 (Journal of Nutrition
and Dietary Supplements)
Get a license, buckle up, and slow down: risky driving patterns among Saudis (Traffic
Injury Prevention)
Low uptake of periodic health examinations in the Kingdom of Saudi Arabia, 2013 (Journal
of Family Medicine and Primary Care)
Self-rated health among Saudi adults: findings from a national survey, 2013 (The Journal
of Community Health)
Access and barriers to health care in the Kingdom of Saudi Arabia, 2013: Findings from a
National Multistage Survey (BMJ open)
71
72. Publications
Manuscripts in review as of June 2015:
On your mark, get set, go: levels of physical activity in the Kingdom of Saudi Arabia, 2013
The health status of Saudi Women: Findings from a national survey
Asthma in the Kingdom of Saudi Arabia: Findings from a national household survey, 2013
Deficiencies under plenty of sun: Vitamin D status among adults in the Kingdom of Saudi
Arabia, 2013
The health of Saudi youth: Current challenges and future opportunities
Use of dental clinics and practices of oral hygiene in the Kingdom of Saudi Arabia, 2013
Cost of diabetes in the Kingdom of Saudi Arabia, 2014
72
73. Outline
Changing burden of disease in the Kingdom of
Saudi Arabia
Saudi Health Interview Survey (SHIS)
• Weighting methodology
• Summary of findings
• Chronic health problems
• Risk factors and health behaviors
• Conclusions and recommendations
• Dissemination of findings
Next steps
73
74. Next steps
• Based on IHME’s preliminary analysis of MOH spending on diabetes
treatment, the Minister created a MOH committee to work with IHME to
analyze MOH spending on hypercholesterolemia and hypertension
• This analysis will also aim to project how much the MOH will spend in the
future on borderline patients if they do not take action and end up fully
developing the condition.
• Household interview: aims to capture indicators on wealth
index, functional health, maternal and child health, chronic and
infectious diseases, mortality, and health facility access and satisfaction
• Health facility survey: aims to capture indicators related to a facility’s
capabilities as well as patient accessibility and satisfaction
• Exit interview: at select health facilities, patients will be interviewed to get
feedback on how to improve services and reduce bottlenecks
Saudi health census
Saudi health expenditure
74
75. The importance of the Saudi Health Census
• It will provide the MOH with a better understanding of health needs
at the regional and sub-regional levels.
• It will help inform the design and implementation of adequate
interventions and policies tailored to communities’ needs.
• It will be used as an early detection program to identify persons at
risk or with undiagnosed or uncontrolled conditions.
• It will allow the linkage of data from households to health facilities.
This will inform the MOH of bottlenecks in health services and
programs.
76. Next steps
1. Establish a burden of disease unit under Public Health
Directorate linked to Saudi CDC
o Health statistics
o Survey and surveillance team
o Local burden
o Data linkage
o Training
2. Training on burden of disease at IHME and in the Kingdom
o MDs or MOH/regional managers for using the findings
o Data methodologies (preferably non-MDs)
o Communication
3. KSA regional burden of disease
76
77. Acknowledgments
The Institute for Health Metrics and Evaluation would like to
thank the Saudi Ministry of Health and all who have
participated and supported this ongoing collaboration.
77