The Burden of Hypertension and Diabetes in an Emergency Department in Northern Tanzania

Ethn Dis. 2019 Oct 17;29(4):559-566. doi: 10.18865/ed.29.4.559. eCollection Fall 2019.

Abstract

Introduction: Little is known about the burden of hypertension and diabetes on emergency department (ED) utilization and hospitalizations in sub-Saharan Africa.

Methods: A retrospective review of adult ED patients in northern Tanzania was performed from September 2017 through March 2018. Hypertension was defined as documented diagnosis of hypertension or blood pressure ≥ 140/90 mm Hg. Diabetes was defined as documented diagnosis of diabetes mellitus or random glucose ≥ 200 mg/dL.

Results: Of 3961 adult ED patients, 1359 (34.3%) had hypertension, 518 (13.1%) had diabetes, and 273 (6.9%) had both. Both hypertension (OR 1.42, 95% CI 1.23-1.63, P<.001) and diabetes (OR 2.05, 95% CI 1.66-2.54, P<.001) were associated with increased odds of admission. Of 2418 hospital admissions, 694 (28.7%) were for complications of hypertension or diabetes. Of 499 patients admitted for hypertensive complications, the most common admission diagnoses were: heart failure (163 patients, 32.7%); stroke (147 patients, 29.5%); and severe hypertension (139 patients, 27.9%). Of 278 patients admitted for diabetic complications, the most common admission diagnoses were: hyperglycemia (158 patients, 56.9%); infection (60 patients, 21.6%); and stroke (28 patients, 10.1%).

Conclusions: The burden of hypertension and diabetes in a Tanzanian ED is high, and the ED may serve as an opportune location for case identification and linkage-to-care interventions. Given the large proportion of Africans with undiagnosed hypertension and diabetes, an ED-based screening program would likely identify many new cases of these diseases. The high burden of hypertension- and diabetes-related hospitalizations highlights the urgent need for improvements in primary preventative care in Tanzania.

Keywords: Diabetes; Emergency Department; Hypertension; Sub-Saharan Africa; Tanzania.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Diabetes Complications / blood
  • Diabetes Complications / complications*
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Heart Failure / etiology
  • Hospitalization / statistics & numerical data*
  • Humans
  • Hyperglycemia / etiology
  • Hypertension / complications*
  • Hypertension / physiopathology
  • Infections / etiology
  • Male
  • Middle Aged
  • Retrospective Studies
  • Stroke / etiology
  • Tanzania