The impact of COVID-19 on mortality among diabetic and hypertensive individuals in coastal communities in Bangladesh: evidence from chakaria health and demographic surveillance system

Abstract

BACKGROUND: COVID-19 was initially considered to be primarily a respiratory illness. However, it soon became evident that individuals with non-communicable diseases (NCDs), particularly Diabetes Mellitus (DM) and Hypertension (HTN), faced a markedly higher risk of severe illness and death. This study assessed excess mortality during the COVID-19 pandemic among individuals living with DM and HTN in rural coastal communities in Bangladesh. METHODS: The study utilised data from the Chakaria Health and Demographic Surveillance System (HDSS), located in the rural sub-district of Chakaria in southeast Bangladesh on the coast of the Bay of Bengal, and operated by the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Prior to the COVID-19 pandemic, 15,700 individuals were screened for DM and HTN, of whom 8506 aged 18 years or older were included in this study. Crude mortality rates (MR) per 1000 person-years (PYR) were estimated by age, sex, education, and household wealth quintile for individuals with DM/HTN compared to those without, both before and during the pandemic. A Cox proportional hazards model was used to examine differences in mortality risk during the pandemic between individuals with and without DM/HTN, adjusting for sociodemographic factors. RESULTS: Among the 8506 study participants, 2.7% (n = 232) had DM, 4.8% (n = 407) had HTN, less than 1% (n = 75) had both conditions and 6.6% (n = 564) had either condition. Among individuals without DM/HTN, the crude MR was 7.1 per 1000 PYR overall (6.9 before COVID-19, 7.5 during); among those with DM/HTN, the crude MR was 28.8 overall (21.2 before, 44.5 during). After adjusting for socio-demographic factors, mortality did not increase significantly during COVID-19 among individuals without DM/HTN. However, among those with DM/HTN, adjusted mortality risk during COVID-19 was nearly twice as high as in the pre-COVID-19 period (Hazard Ratio (HR) = 1.89; 95% CI: 1.22-2.91; p < 0.01). CONCLUSION: The COVID-19 pandemic significantly increased all-cause mortality among individuals with DM or HTN in the rural sub-district of Chakaria in southeast Bangladesh on the coast of the Bay of Bengal through direct and indirect pathways.