*3.2. Prevalence of Hypertension and Associated Factors*

About 27.8% of the study participants were hypertensive (Figure 1). The mean systolic blood pressure was 127.52 ± 18.24 mmHg, and the mean diastolic blood pressure was 83.13 ± 11.95 mmHg. When exploring the factors associated with hypertension, we noted that increased age was associated with an increased likelihood of having hypertension (AdjOR: 1.10, 95% CI: 1.07–1.13), and being male (AdjOR: 2.42, 95% CI: 1.12–5.24) compared to female, current alcohol drinking (AdjOR: 2.80, 95% CI: 1.41–5.57), and overweight (AdjOR: 5.88, 95% CI: 2.99–11.55) and obese (AdjOR: 6.10, 95% CI: 1.96–8.99), in terms of BMI, resulted in higher risk of hypertension (Table 2). *Int. J. Environ. Res. Public Health* **2022**, *19*, x FOR PEER REVIEW 6 of 10

Sex

Current alcohol drinking

Current smoking

Exercise

Central obesity

Body Mass Index

\* *p* value ≤ 0.05; \*\* *p* value ≤ 0.01.

**4. Discussion** 

**Figure 1.** Prevalence of hypertension among Myanmar migrant workers in Chiang Mai, Thailand (2017). **Figure 1.** Prevalence of hypertension among Myanmar migrant workers in Chiang Mai, Thailand (2017).

Female 31 (16.9) Referent

No 46 (18.8) Referent

No 69 (22.6) Referent

Yes 19 (30.2) Referent

No 79 (25.5) Referent

Normal 18.5–24.9 68 (20.7) Referent

**Table 2.** Factors associated with hypertension among Myanmar migrant workers in Thailand.

Age (years) 1.10 \*\* 1.07 1.13

Male 84 (36.4) 2.42 \* 1.12 5.24

Yes 69 (40.8) 2.80 \* 1.41 5.57

Yes 46 (42.2) 1.21 0.64 2.29

No 96 (27.4) 1.26 0.62 2.56

Yes 35 (34.0) 1.18 0.61 2.29

Overweight 25–29.9 37 (54.4) 5.88 \*\* 2.99 11.55 Obese ≥ 30 10 (55.6) 6.10 \*\* 1.96 18.99

We noted the important finding that 27.8% of the current study participants were hypertensive, a higher percentage than that of the host country (24.7%) and country of origin (26.4%) [1]. Hypertension was also more prevalent than in another study conducted among Shan migrant workers in Northern Thailand in 2011 (23.5%), comparable with the prevalence of hypertension among the Karen ethnic minority in Thailand (27.0%) and lower than that of South East Asian immigrants in the United States (29.1%)[17–19]. Agerelated increases in blood pressure owing to vascular aging have been observed in almost every population, and we also noted that the increasing age of the study participants was associated with a higher prevalence of hypertension [20,21].Distinct gender differences in the incidence and severity of hypertension were well-established, and hypertension was more common in men than women [22,23]. It is evident that blood pressure levels and

*n* **(%) Adjusted OR Lower Upper** 


**Table 2.** Factors associated with hypertension among Myanmar migrant workers in Thailand.

\* *p* value ≤ 0.05; \*\* *p* value ≤ 0.01.

#### **4. Discussion**

We noted the important finding that 27.8% of the current study participants were hypertensive, a higher percentage than that of the host country (24.7%) and country of origin (26.4%) [1]. Hypertension was also more prevalent than in another study conducted among Shan migrant workers in Northern Thailand in 2011 (23.5%), comparable with the prevalence of hypertension among the Karen ethnic minority in Thailand (27.0%) and lower than that of South East Asian immigrants in the United States (29.1%) [17–19]. Agerelated increases in blood pressure owing to vascular aging have been observed in almost every population, and we also noted that the increasing age of the study participants was associated with a higher prevalence of hypertension [20,21]. Distinct gender differences in the incidence and severity of hypertension were well-established, and hypertension was more common in men than women [22,23]. It is evident that blood pressure levels and hypertension increase with age in both sexes; however, men have higher blood pressure at a younger age than women [24,25]. Numerous previous observational epidemiological studies have supported that alcohol consumption can elevate blood pressure, and previous studies noted that males drank significantly more alcohol than females [26–28]. Being male per se is one of the non-modifiable CVD risk factors, and our finding of current alcohol drinking and its association with hypertension is an important but alarming issue in the goal of preventing hypertension by the modification of lifestyles among male migrant workers.

About 26.3% of study participants were current daily smokers, which was higher than Thailand's 2021 national figure of 17.0% and that of Myanmar of 15.0% [29]. The effects of tobacco smoking on hypertension are complex, and it is evident that smoking raises blood pressure over time. Moreover, both smoking and hypertension act as independent risk factors for cardiovascular diseases [30,31]. Even though we did not find any significant association of current smoking status with hypertension, the higher prevalence of current daily smokers in this study should be considered for the prevention of NCDs and subsequent burdens. Furthermore, less than a quarter of participants had regular exercise habits

(15.2%), and the proportion of physical inactivity in this study population (84.8%) was also higher than that of the host (25.0%) and native country (10.0%) [1]. One-third of study participants could have adequate sleeping hours (>8 h per night). However, hypertension was not significantly affected by "no exercise" and lack of sleep in this study.

The association of obesity with hypertension was explored both in terms of central obesity by the sex-specific waist/hip ratio and overweight/obesity by the BMI. We did not find any significant association of central obesity with hypertension whereas the overweight and obese study participants (in terms of the BMI) had significantly higher association with hypertension than those with a normal BMI. The risk of hypertension among overweight participants was as high as among obese ones (about six times higher than their normal BMI counterparts). Pre-existing literature reported that excessive body weight (high BMI) is an important determinant of hypertension, and obese people had a higher risk of developing hypertension when compared to people with normal weight. This obesity-associated hypertension may be due to abnormal kidney function with a subsequent increase in blood pressure [32–34].

Our findings highlighted the prevalence of hypertension and its associated behavioral risk factors among young, working migrants, to prevent NCDs, which would be valuable in maintaining a healthy workforce and increasing productivity in a host country. Moreover, currently, the burden of the COVID-19 pandemic may affect NCDs. As of November 2021, over 260 million confirmed COVID-19 cases and nearly 5.2 million deaths have been reported globally. Persons with chronic diseases, such as NCDs and other diseases, have a greater risk of severe COVID-19, probably leading to higher mortality or prolonged hospitalization. Additionally, the postponement or interruption of NCD care and pandemic containment measures such as lockdown and social distancing may increase unhealthy lifestyle behaviors, such as poor diets, alcohol, and physical inactivity, which may constitute increased risks for NCDs and subsequent negative impacts on morbidity and mortality [35].

#### *Limitation and Strength of This Study*

The generalizability of our findings to represent all Myanmar migrant workers in Thailand is affected by the fact that most of the study participants are ethnic Shan due to the geographical proximity between Chiang Mai, Thailand, and the Shan state of Myanmar. Another limitation of the present study is that information about poor diet, especially salt intake, is missing. Assessment of renal function to exclude an important disease underlying hypertension was not included in this cross-sectional survey, adding one more limitation to this study. The family history of hypertension could not be explored, as participants could neither remember the history of their family nor realize the importance of such family history. The prevalence of hypertension, as determined by the objective assessment of resting blood pressure in a crowded data-collection site and repeating BP measurements a second time only for those whose initial BP was over 140/90 mmHg, may limit the main outcome of this study. However, reaching a vulnerable population with well-validated questionnaires and well-trained research assistants who were able to speak three languages (Thai, Shan, and Myanmar) of the targeted study population strengthened the valuable findings of our study.

#### **5. Conclusions**

Despite the limitations, our study reaffirmed that NCDs are important public health concerns among the migrant population. Moreover, the measurement of BMI to determine hypertension risks would be a valuable, easy, and simple assessment tool. Our findings also provided insights into the epidemiological patterns of risk behaviors of hypertension, which could impact the negative consequences of NCDs and the global workforce. Even though they share the same NCDs risk factors with people of the host country and those of the native country, they may have more potential risks due to lack or inaccessibility of health care services in Thailand. This may put them at risk of developing hypertension and an increased burden of NCDs while in the host country and once they return home. Targeted

surveillance and urgent health policy are recommended for this migrant population in Thailand by strengthening partnerships in cross-border and international global health.

**Author Contributions:** Conceptualization, T.N.N.A., Y.S. and M.N.A.; data curation, T.N.N.A. and S.M.; formal analysis, T.N.N.A. and S.M.; funding acquisition, Y.S.; investigation, T.N.N.A. and S.M.; methodology, T.N.N.A., S.M. and M.N.A.; project administration, T.N.N.A., S.M., T.L., W.J. and M.N.A.; resources, Y.S., M.Y. and M.N.A.; software, T.N.N.A. and S.M.; supervision, M.Y.; validation, T.N.N.A., S.M. and M.N.A.; visualization, M.N.A.; writing—original draft, T.N.N.A. and M.N.A.; writing—review and editing, T.N.N.A., Y.S., S.M., T.L., W.J., M.Y. and M.N.A. All authors have read and agreed to the published version of the manuscript.

**Funding:** The Japanese Ministry of Education financially supported this study (Grants 15K 08822, 18K 10110, and 20K 10478).

**Institutional Review Board Statement:** The study was conducted in accordance with the Declaration of Helsinki. The Ethical Review Committee for Research in Human Subjects: Boromarajonani College of Nursing Nakhon Lampang. Praboromarajchnok, Institute for Health Workforce Development, Ministry of Public Health, Thailand (approval number E 2560/39, dated 31 October 2017) approved ethics.

**Informed Consent Statement:** Written informed consent has been obtained from all study participants to participate in this study and to publish the research findings while preserving their anonymity.

**Data Availability Statement:** The data will be available from the corresponding author upon a reasonable request.

**Acknowledgments:** All study participants and staff from the provincial employment office, Chiang Mai, Thailand, are acknowledged for their collaboration for data collection there.

**Conflicts of Interest:** The authors declare no conflict of interest.
