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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 29  |  Issue : 4  |  Page : 991-995

Prevalence of hypertension and its associated factors among cotton textile workers of Kannur, Kerala


Department of Community Medicine, Kannur Medical College, Anjarakandy, Kannur, Kerala, India

Date of Submission08-Oct-2014
Date of Acceptance06-Jan-2015
Date of Web Publication21-Mar-2017

Correspondence Address:
Imaad Mohammed Ismail
Department of Community Medicine, Kannur Medical College, Anjarakandy, Kannur - 670 612, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.202520

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  Abstract 

Introduction
Hypertension is a challenging disease in developing countries like India as majority of the cases remain undiagnosed in the community. Work related mental stress, improper diet, smoking, alcoholism and high level of oxidative stress are important factors which may contribute for development of hypertension among the cotton textile workers.
Objectives
To estimate the prevalence of hypertension and identify its associated risk factors among cotton textile workers of Kannur.
Methodology
It was a cross-sectional study conducted in Kannur district from Dec 2013 to Aug 2014. Sample size required for the current study was 400 and it was calculated using the formula 4pq/l2. There are 35 cotton textile factories in Kannur out which 3 were selected using simple random sampling. These factories have various departments such weaving, spinning, dyeing, blowing, carding, roving, cone winding and packing. Using systematic random sampling, the required number of sample was selected. Data was collected using a pre-tested questionnaire among individuals aged 18 years and above. JNC-8 criteria were used for diagnosis of hypertension. Data analysis was done on SPSS 19.
Results
The prevalence of hypertension and pre-hypertension among cotton textile workers was 22.3% and 38% respectively. Increasing age, alcohol consumption, family history of hypertension, BMI >25 kg/m2 and high waist-hip ratio were found to significant risk factors of hypertension.
Conclusion
The prevalence of hypertension among cotton textile workers was on par with the prevalence in general population of India which is 21%. Health education on behaviour change should be regularly conducted among the workers of these factories in order to reduce the risk factors of hypertension.

Keywords: Hypertension, cotton textile industry, JNC 8, Obesity


How to cite this article:
Ismail IM, Binub K. Prevalence of hypertension and its associated factors among cotton textile workers of Kannur, Kerala. Menoufia Med J 2016;29:991-5

How to cite this URL:
Ismail IM, Binub K. Prevalence of hypertension and its associated factors among cotton textile workers of Kannur, Kerala. Menoufia Med J [serial online] 2016 [cited 2020 Feb 16];29:991-5. Available from: http://www.mmj.eg.net/text.asp?2016/29/4/991/202520


  Introduction Top


Hypertension is a silent killer disease accounting for 9.4 million deaths worldwide every year [1]. In order to highlight the importance of the global public crisis caused by this disease, WHO declared the 2013 world health day theme as “high blood pressure”. Hypertension is responsible for 42% of coronary heart disease deaths and 57% of all stroke deaths in India [2]. It's a challenging disease in low and middle income countries like India as large majority of the cases remains undiagnosed in the community.

Epidemiological studies have shown that oxidative stress is high in cotton textile workers [3] and oxidative stress leads to development of essential hypertension [4],[5]. Work related mental stress, noisy environment, improper diet, tobacco smoking, harmful intake of alcohol are other important factors which may contribute towards development of hypertension among the cotton textile workers [6-8].

As only a couple of studies on hypertension among cotton textile workers were conducted in India, a study in this regard was required to identify the magnitude of the problem in this occupational group. Hence this study was conducted with the objective of estimating the prevalence of hypertension and identifying its associated risk factors among cotton textile workers of Kannur.


  Materials and Methods Top


It was a cross-sectional study conducted in Kannur from Dec 2013 to Aug 2014. Kannur is major coastal district located in North Kerala which is popular for its handloom industry; hence it is also referred to as city of “looms and lores”. Sample size required for the current study was 400 and it was calculated using the formula 4pq/l 2 (prevalence of 20% and relative precision of 20% was considered for sample size calculation at 95% confidence level) [6]. There are 35 cotton textile factories in Kannur out of which 3 factories were selected using simple random sampling. 2 were spinning and 1 was a weaving factory. These factories have various departments such as weaving, spinning, dyeing, blowing, carding, roving, cone winding and packing. All these departments were included for sampling. A list of all workers in the selected factory was taken from the management and using systematic random sampling, the required number of sample was selected. Permission to conduct the study was taken from the managers of the factories and written informed consent was taken from the study participants. Ethical clearance was taken from the Institutional Ethical Committee.

All individuals aged 18 years and older were selected for the study. Pregnant women and those who were not willing to participate in the study were excluded. A pre-tested, structured questionnaire was used to collect data. Data on socio-demographic variables, diet, smoking, alcohol consumption, physical activity, perceived stress, family history of hypertension was collected. Perceived stress scale 4 (PSS 4) was used to measure the perceived stress level [9]. Weight was recorded using an electronic weighing machine and was rounded off to the nearest 0.5 kg. For measuring height, the subject was made to stand erect looking straight on a level surface and height was read to the nearest 0.5 cm. Waist circumference was measured to the nearest 1 mm using a non elastic plastic tape with the subject in standing position midway between the lower rib margin and the iliac crest. Hip circumference was measured around the widest portion of the buttocks with the tape parallel to the floor.

Blood pressure was recorded in the right arm with the subject in seating position using a mercury sphygmomanometer. Two reading were taken and the average of these reading was considered for analysis. The first reading was taken after at least 15 min of rest and the second reading was taken 15 min after the first reading. JNC-8 criteria were used for diagnosis of hypertension [10]. Hypertension was defined as systolic blood pressure more than or equal to 140 mmHg and/or diastolic blood pressure more than or equal to 90 mmHg. Individual aged ≥65 years were considered to be hypertensive if their systolic blood pressure more than or equal to 150 mmHg and/or diastolic blood pressure more than or equal to 90 mmHg. Those individuals already diagnosed as hypertensive were also labeled as such. Data entry and analysis was done on SPSS version 19 (Statistical Package for Social Sciences, SPSS Inc., Chicago). Proportions, Chi-square test, Pearson correlation, multiple logistic regression were used for analysis and P value of less than 0.05 was considered to be significant.


  Results Top


A total of 719 workers were present in the 3 selected cotton textile factories, out of which 6 were pregnant and excluded from the study. 400 sampled individuals from the three factories working in various departments were interviewed and examined ([Table 1]). The average work duration per day was 8 hours. The mean age and experience of the workers was 43.6 (SD ± 9.9) years and 13 (SD ± 10) years respectively. Most of the workers were in the age group of 30 to 60 years (Chart 1). 89.5% among them were married, 76.3% of the worker force was from rural areas and the rest from urban areas. 234 (58.5%) of the study participants were females. Large proportions (43.35%) of workers of these factories were 10th Std pass. Around 60% of the study participants belonged to class III and class IV socio-economic class according to modified B G Prasad's classification (CPI 2014) ([Table 2]).
Table 1 Distribution of the study participants according their work departments

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Table 2 Socio-economic class of the study participants

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The prevalence of hypertension and pre-hypertension among cotton textile workers was 22.3% and 38% respectively ([Table 3]). Prevalence of hypertension was 25.3% among males and 20.1% among females; this difference was statistically insignificant ([Table 4]). Place of residence whether urban or rural had similar rates of hypertension. The distribution of hypertensives was alike in all the socio-economic groups and no difference was found (p 0.61). There was no statistically significant difference in prevalence of hypertension with regard to various work departments (p 0.41).
Table 3 Blood pressure classification according to JNC-8 Criteria

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Table 4 Frequency of study variables among hypertensives and normotensives

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Out of the total workers, 40.3% reported that they consume fruits daily and most of them have 1 serving of fruit per day as against the recommended minimum of 2 servings/per day. With regard to vegetables, 65.7% reported to be consuming vegetables on a daily basis and majority of them consumed only 1 serving of vegetables per day as against the recommended 5 servings/per day. No association was found between hypertension and fruit or vegetable intake pattern. Alcohol consumption, family history of hypertension, diabetes mellitus, BMI ≥25 kg/m 2 and high waist-hip were significantly more frequent among the hypertensive than normotensive workers ([Table 4]). Multiple logistic regression analysis revealed increasing age, alcohol consumption, family history of hypertension, BMI ≥25 kg/m 2 and high waist-hip to be significant risk factors for the development of hypertension ([Table 5]).
Table 5 Multiple logistic regression analysis

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  Discussion Top


The prevalence of hypertension among cotton textile workers of Kannur was on par with the prevalence in general population of India which is 21% [1]. According to the phase 1 IDSP survey report the prevalence of hypertension in Kerala population is 18% [11]. The present study finding are similar to a study conducted by Tiwai RR et al. among cotton textile workers of Wardha who found the prevalence to be 20.2% [6]. Although the prevalence of hypertension in this occupational group is similar to the general population, it is still a high prevalence for any given disease which is associated high mortality and morbidity. The prevalence of pre-hypertension was very high (38.5%) and the subjects in this group are potential candidates to develop hypertension in future. Non-modifiable risk factors such as age and family history of hypertension; and modifiable risk factors such as alcohol consumption and central obesity were found to be significant risk factors for the development of hypertension in this study group.

The prevalence of hypertension was 11.4% in the age group 21-30 years; this increased to 26.5% in the age group 41-50 years, which further increased to 33.3% in the age group 61-70 years. The study found age more than 40 years to be an important non-modifiable risk factor of hypertension. Due to ageing there is acceleration in atherosclerosis process and there is gradual loss in elasticity of arteries and arterioles which results in high blood pressure. With respect to the work departments, the prevalence of hypertension was higher in workers of blowing (29.3%) and dying (30.7%) departments but this difference was not statistically significant.

Kerala accounts for highest alcohol consumption in the country according to Indian Alcohol Policy Alliances (IAPA). 50.6% of males and 7.3% females in the current study reported to have consumed alcohol in the past 12 months. Among those who consume alcohol 18.8% took it on a daily basis and 43.6% reported to have consumed more than 2 standard drinks (>1 standard drink for female) in a single sitting over the past 30 days. The mean (± SD) duration of alcohol intake was 15.1 (±10.3) years. The current study found alcohol intake to be a risk factor for development of hypertension. Mechanisms underlying the relationship between alcohol and blood pressure remain ambiguous; some suggested mechanisms include stimulation of the sympathetic nervous system and the renin–angiotensin–aldosterone system, raised cortisol levels, inhibition of nitric oxide, depletion of ions, increased intracellular calcium especially in vascular smooth muscle, mediated by changes in electrolyte transport and alteration of insulin resistance [12].

Hypertension has a strong genetic component and runs in families [13]. This was found to be true in this study as the prevalence of hypertension among those who had family history of hypertension (either father or mother suffering from hypertension) was higher compared to those who did not have a family history (P < 0.05).

Obesity is a known risk factor for development of hypertension and similar findings were seen in the present study where BMI ≥25 kg/m 2 was found to be an important risk factor. Starzynski Z et al. conducted a study among cotton textile workers of Lodz, Poland also found obesity to be an important risk factor of hypertension [7]. Obesity associated arterial hypertension is characterized by activation of the sympathetic nervous system, activation of the renin-angiotensin system, and sodium retention [14]. High waist-hip ratio also called as central obesity is a particularly important risk factor for development of hypertension and cardiovascular disease in Asian population [15]. Many studies conducted in various groups in India have found central obesity to be strongly associated with hypertension [16]. In the present study the prevalence of hypertension was 25.6% and 16.7% among high-waist hip ratio workers and normal waist-hip ratio workers respectively, and this difference was found to be significant (P < 0.05). Frequency of hypertension was more common among diabetics than non diabetics but on applying multiple logistic regression diabetes was not found to be a significant risk factor for development of hypertension.

Perceived Stress Scale 4 used in this study has a minimum score of 0 to a maximum score of 16, higher scores indicate higher perceived stress levels [9]. A large portion of cotton textile workers (78.6%) had a score between 9 to 12. No association was found between perceived stress scores and hypertension in the present study (p 0.358).

Smoking was not found to be a risk in the present study, this might be due to the fact that only 38 (9.5%) out of the total 400 smoked and the frequency of smoking was low. 34 out of the 38 smokers used cigarette and 61.7% of them reported to consume 2 to 4 cigarettes per day. Surprisingly in the current study use of extra salt such as table salt was not found to be a risk factor for hypertension, this may be accounted by the dietary practice of the people of Kannur who consume lot of pickle in their food which is rich in salt and hence reducing the necessity to add extra table salt to their meal. The present study did not analyse the total salt intake of workers from different sources and correlate it with their blood pressure status which is a limitation of this study.


  Conclusion and Recommendations Top


Although the prevalence of hypertension among cotton textile workers (22.3%) was similar to the general population, it is still a high prevalence when compared to the world scenario and all efforts should be done to bring down the prevalence.

Among those who were hypertensive, lifestyle risk factors such as alcohol consumption and obesity were significantly associated with hypertension. This necessitates the need to educate and motivate them to quit alcohol and also maintain their body weight in the normal range. Individuals aged 40 years and above were at a higher risk of developing hypertension and they should be annually screened for hypertension so as to detect and treat them early.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
World Health Organization. A global brief on hypertension. WHO/DCO/WHD/2013.2. Geneva: WHO 2013. Available from http://www.who.int/cardiovascular_diseases/publications/global_brief_hypertension/en/. [Last accessed on 2014 Jun 17]  Back to cited text no. 1
    
2.
Gupta R. Rethinking Diseases of Affluence; Coronary Heart Disease in Developing Countries. South Asian Journal of Preventive cardiology 2006 Apr-Jun;10(2):65-78.  Back to cited text no. 2
    
3.
Suryakar AN, Katkam RV, Dhadke VN, Bhogade RV. A study on oxidative stress in cotton textile workers from Solapur city. Biomedical Research 2010;21(3):260-4.  Back to cited text no. 3
    
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Briones AM, Touyz RH. Oxidative stress and hypertension: Current Concepts. Current Hypertension Reports 2010;12(2):135-42.  Back to cited text no. 5
    
6.
Tiwai RR, Pathak MC, Zodpey SP, Babar VY. Hypertension among cotton textile workers. Indian J Public Health 2003;47(1):34-6.  Back to cited text no. 6
    
7.
Starzynski Z, Wilczynska U, Kubasiewicz M, Szymczak W. Incidence of arterial hypertension in the population of workers in the textile industry in Lodz. Med Pr 1985;36(2):131-8.  Back to cited text no. 7
    
8.
Rizi HAY, Dehghan H. Effects of occupational noise exposure on changes in blood pressure of workers. ARYA Atherosclerosis Journal 2012;8:183-6.  Back to cited text no. 8
    
9.
Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. Journal of Health and Social Behavior 1983;24:385-96.  Back to cited text no. 9
    
10.
James PA, Oparil S, Carter BL, Cushman WC, Himmelfarb CD, Handler J, Lackland DP et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults, The JNC 8 Report. JAMA 2014;311(5):507-520.  Back to cited text no. 10
    
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IDSP, Non-communicable disease risk factor survey phase-1. Department of Health and Welfare, New Delhi, Govt. of India, 2013.  Back to cited text no. 11
    
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Yamada Y, Noborisaka Y, Ishizaki M, Tsuritani I, Honda R, Yamada S. Alcohol consumption, homeostasis model assessment indices and blood pressure in middle-aged healthy men. Journal of Human Hypertension 2004;18:343-50.  Back to cited text no. 12
    
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Dickson ME, Sigmund CD. Genetic Basis of Hypertension: Revisiting Angiotensinogen. Hypertension 2006;48:14-20.  Back to cited text no. 13
    
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Richard NE. Obesity related hypertension. The Ochsner Journal 2009;9:133-6.  Back to cited text no. 14
    
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Gill TP. Cardiovascular risk in Asia-pacific region from a nutrition and metabolic point of view: abdominal obesity. Asia Pacific J Clin Nutr 2001;10(2):85-9.  Back to cited text no. 15
    
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Ismail IM, Kulkarni AG, Kamble SV, Borker SA, Rekha R, Amruth M. Prevalence of hypertension and its risk factors among bank employees of Sullia Taluk, Karnataka. Sahel Med J 2013;16:139-43.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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