Relationship between hypertension, diabetes and proteinuria in rural and urban households in Yemen

Little information is available on the meanings of proteinuria in low-resource settings. A population-based, cross-sectional survey was performed in Yemen on 10 242 subjects aged 15–69 years, stratified by age, gender and urban/rural residency. Hypertension is defined as systolic blood pressure (BP) of ⩾140 mm Hg and/or diastolic BP of ⩾90 mm Hg, and/or self-reported use of antihypertensive drugs; diabetes is diagnosed as fasting glucose of ⩾126 mg dl−1 or self-reported use of hypoglycaemic medications; proteinuria is defined as ⩾+1 at dipstick urinalysis. Odds ratios (ORs) for associations were determined by multivariable logistic regression models. Prevalence (weighted to the Yemen population aged 15–69 years) of hypertension, diabetes and proteinuria were 7.5, 3.7 and 5.1% in urban, and 7.8, 2.6 and 7.3% in rural locations, respectively. Proteinuria and hypertension were more prevalent among rural dwellers (adjusted ORs 1.56; 95% confidence limit (Cl) 1.31–1.86, and 1.23; 1.08–1.41, respectively), diabetes being less prevalent in rural areas (0.70; 0.58–0.85). Differently from hypertension and diabetes, proteinuria was inversely related with age. Most importantly, 4.6 and 6.1% of urban and rural dwellers, respectively, had proteinuria in the absence of hypertension and diabetes. The approach of considering kidney damage as a consequence of hypertension and diabetes might limit the effectiveness of prevention strategies in low-income countries.