Association between risk factors and mortality in patients with non-communicable diseases in eight Kenyan counties: An observational cohort study

Abstract

Objectives: The risk-factors associated with deaths from Non-Communicable Diseases (NCDs) have not been studied in Kenya. The objective of this study was to identify risk factors for death among patients diagnosed and treated for hypertension, diabetes and  asthma.

Design, Setting and Subjects: A total of 639 individuals diagnosed and prescribed treatment for hypertension, diabetes or asthma  were identified in a representative sample in eight Kenyan counties in 2016. The individuals were followed via three-monthly phone calls until 2019. Risk factors for mortality were quantified.

Main Outcome Measure: Mortality

Results: Of the 639 individuals studied 445 had hypertension of whom 43 died (9.6%), 69 patients had diabetes of whom 11 died (15.9%) and 113 had asthma of whom 7 died (6.2%). Significant risk factors for death were older age [OR= 1.033 (1.016, 1.050) p=0.0001]. There was a reduced risk by being female [OR= 0.442 (0.260, 0.750) p= 0.0025], having primary or secondary education [OR= 0.611  (0.420, 0.887) p= 0.0097], and belonging to a higher wealth quintile [OR= 0.787 (0.649, 0.953) p= 0.0143]. Risk factors not associated with mortality for all cases included county of residence, marital status, number of NCD patients in the household or numbers of NCDs per patient.

Conclusion: The risk factors of older age, male sex, no education and low wealth have been shown to have significant associations with mortality. Clinicians managing patients with these conditions should recognize that older male patients with no education and from the poorer households have the highest risk of mortality.