{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T11:57:55Z","timestamp":1785499075466,"version":"3.56.0"},"reference-count":31,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:00:00Z","timestamp":1781568000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,6,1]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hypertension and type 2 diabetes mellitus (T2DM) frequently co-occur and synergistically increase the risk of cardiovascular and renal complications and premature mortality. This dual burden is particularly critical in post-conflict settings, where disruptions in healthcare infrastructure and chronic disease management may accelerate disease progression. Following the recent conflict in Tigray, northern Ethiopia, health services and medication supply systems were severely affected. We examined the joint longitudinal progression and determinants of hypertension and T2DM in a post-conflict clinical setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study was conducted at Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia. Medical records of 1024 adults (\u226518 years) with hypertension and\/or T2DM and at least three follow-up visits (December 2022\u2013April 2024) were reviewed. Repeated measures of systolic\/diastolic blood pressure and fasting blood glucose (FBG) were analysed using a joint linear mixed-effects model to simultaneously estimate correlated trajectories and shared random effects. Demographic, behavioural, clinical and healthcare utilisation variables were included as fixed effects. Model assumptions and goodness-of-fit were assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Participants had a mean age of 49 years and mean body mass index of 27.2 kg\/m\u00b2; 60.0% were female and 81.9% resided in urban areas. Overweight and behavioural risk factors were common. Increasing age and body weight were independently associated with higher longitudinal blood pressure and FBG levels (p&lt;0.05). Smoking, alcohol use and lower visit frequency were significantly associated with poorer glycaemic control. The joint model demonstrated a significant positive association parameter between blood pressure and FBG trajectories, indicating correlated disease progression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Hypertension and T2DM progress in a closely interrelated manner in post-conflict Tigray, influenced by both modifiable and non-modifiable factors. Integrated chronic disease management, strengthened follow-up systems and resilient supply chains are essential during health system recovery in fragile settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-004235","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T12:20:12Z","timestamp":1781612412000},"page":"e004235","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Joint progression and determinants of hypertension and type 2 diabetes among adults in post-conflict Tigray, Ethiopia: implications for chronic disease care in fragile health systems"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0351-1143","authenticated-orcid":false,"given":"Abdukadir Nigus","family":"Mohammed","sequence":"first","affiliation":[{"name":"Chief Executive Officer, Alamata General Hospital, Alamata, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6474-4055","authenticated-orcid":false,"given":"Edris Abdu","family":"Debesay","sequence":"additional","affiliation":[{"name":"Medical Director, Lekatit-11 Primary Hospital, Mekelle, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashagire Zenebe","family":"Woldearegawi","sequence":"additional","affiliation":[{"name":"Public Health, Adigrat University College of Medicine and Health Sciences, Adigrat, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"2026073104050510000_4.3.e004235.1","article-title":"Hypertension and diabetes prevalence and risk factors in urban and rural Ethiopia: a population-based study","volume":"17","author":"Abebe","year":"2017","journal-title":"BMC Public Health"},{"key":"2026073104050510000_4.3.e004235.2","article-title":"Cardiovascular disease risk factors in Ethiopia: urban versus rural","volume":"13","author":"Tesfaye","year":"2016","journal-title":"Prev Chronic Dis"},{"key":"2026073104050510000_4.3.e004235.3","first-page":"106","article-title":"Overweight, hypertension and diabetes in urban adults in Addis Ababa: magnitude and associated factors","volume":"18","author":"Gebremedhin","year":"2018","journal-title":"BMC Cardiovasc Disord"},{"key":"2026073104050510000_4.3.e004235.4","first-page":"10","article-title":"The impact of lifestyle factors on hypertension and type 2 diabetes in Tigray, Ethiopia","volume":"33","author":"Alemayehu","year":"2019","journal-title":"Ethiop J Health Dev"},{"key":"2026073104050510000_4.3.e004235.5","first-page":"124","article-title":"Gender differences in non-communicable disease risk factors: evidence from northern Ethiopia","volume":"11","author":"Kidane","year":"2020","journal-title":"J Public Health Afr"},{"key":"2026073104050510000_4.3.e004235.6","first-page":"67","article-title":"Effects of urbanization on chronic disease prevalence in Tigray region","volume":"59","author":"Fikadu","year":"2021","journal-title":"Ethiop Med J"},{"key":"2026073104050510000_4.3.e004235.7","unstructured":"Tsegaye B , Alemayehu M . Alcohol consumption and hypertension among adults in Ethiopia: a systematic review. Int J Hypertens 2018;8578943."},{"key":"2026073104050510000_4.3.e004235.8","first-page":"1041","article-title":"Alcohol intake and risk of type 2 diabetes in Ethiopian adults","volume":"12","author":"Haile","year":"2019","journal-title":"Diabetes Metab Syndr Obes"},{"key":"2026073104050510000_4.3.e004235.9","article-title":"Social support and chronic disease management in Ethiopia: a population-based study","volume":"20","author":"Berhane","year":"2020","journal-title":"BMC Public Health"},{"key":"2026073104050510000_4.3.e004235.10","first-page":"214","article-title":"Cigarette smoking and hypertension in adults of northern Ethiopia","volume":"28","author":"Woldemichael","year":"2017","journal-title":"Cardiovasc J Afr"},{"key":"2026073104050510000_4.3.e004235.11","first-page":"89","article-title":"Tobacco use and its effect on type 2 diabetes among Ethiopian adults","volume":"29","author":"Fikru","year":"2019","journal-title":"Ethiop J Health Sci"},{"key":"2026073104050510000_4.3.e004235.12","first-page":"130","article-title":"Gender differences in healthcare utilization and outcomes among patients with chronic diseases in Ethiopia","volume":"17","author":"Mekonnen","year":"2018","journal-title":"Int J Equity Health"},{"key":"2026073104050510000_4.3.e004235.13","first-page":"154","article-title":"Patterns of adherence to treatment in women with hypertension and type 2 diabetes in northern Ethiopia","volume":"20","author":"Gebrehiwot","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"2026073104050510000_4.3.e004235.14","first-page":"145","article-title":"Post-war health system disruption and chronic disease management in Tigray, Ethiopia","volume":"22","author":"Hagos","year":"2022","journal-title":"BMC Health Serv Res"},{"key":"2026073104050510000_4.3.e004235.15","first-page":"101","article-title":"Non-communicable disease burden in post-war Tigray: implications for intervention","volume":"32","author":"Gebrehiwot","year":"2022","journal-title":"Ethiop J Health Sci"},{"key":"2026073104050510000_4.3.e004235.16","unstructured":"Desta M , Woldemariam M . Urban-rural disparities in type 2 diabetes management in Tigray region. Ethiopia J Diabetes Res 2021;6612347."},{"key":"2026073104050510000_4.3.e004235.17","first-page":"55","article-title":"Access to healthcare and glycemic control among type 2 diabetes patients in urban and rural Tigray","volume":"34","author":"Fisseha","year":"2020","journal-title":"Ethiop J Health Dev"},{"key":"2026073104050510000_4.3.e004235.18","article-title":"Treatment adherence in type 2 diabetes patients: a study from northern Ethiopia","volume":"14","author":"Taye","year":"2019","journal-title":"PLoS ONE"},{"key":"2026073104050510000_4.3.e004235.19","article-title":"Physical activity and its association with hypertension and type 2 diabetes in adults of Tigray region, Ethiopia","volume":"21","author":"Gebremedhin","year":"2021","journal-title":"BMC Public Health"},{"key":"2026073104050510000_4.3.e004235.20","first-page":"22","article-title":"Dietary patterns and their impact on non-communicable diseases in Northern Ethiopia","volume":"34","author":"Tsegay","year":"2020","journal-title":"Ethiop J Health Dev"},{"key":"2026073104050510000_4.3.e004235.21","first-page":"747","article-title":"Rural health service utilization and non-communicable disease outcomes in Ethiopia","volume":"18","author":"Hailu","year":"2018","journal-title":"BMC Health Serv Res"},{"key":"2026073104050510000_4.3.e004235.22","first-page":"181","article-title":"Barriers to healthcare access in rural Ethiopia: implications for chronic disease management","volume":"57","author":"Ayele","year":"2019","journal-title":"Ethiop Med J"},{"key":"2026073104050510000_4.3.e004235.23","first-page":"74","article-title":"Gender differences in hypertension and diabetes management in urban Ethiopia","volume":"19","author":"Fikre","year":"2020","journal-title":"Int J Equity Health"},{"key":"2026073104050510000_4.3.e004235.24","first-page":"909","article-title":"Gender differences in medication adherence for hypertension and type 2 diabetes in Northern Ethiopia","volume":"21","author":"Tesfay","year":"2021","journal-title":"BMC Health Serv Res"},{"key":"2026073104050510000_4.3.e004235.25","first-page":"12","article-title":"The effect of socioeconomic status on blood pressure and glucose control in Tigray, Ethiopia","volume":"35","author":"Gebremedhin","year":"2021","journal-title":"Ethiop J Health Dev"},{"key":"2026073104050510000_4.3.e004235.26","unstructured":"Asfaw M , Desta T . Interaction of age, sex, and residence on hypertension and diabetes progression in northern Ethiopia. Int J Hypertens 2021;6619832."},{"key":"2026073104050510000_4.3.e004235.27","first-page":"45","article-title":"Smoking, alcohol consumption, and their association with non-communicable diseases in Tigray","volume":"31","author":"Hailu","year":"2021","journal-title":"Ethiop J Health Sci"},{"key":"2026073104050510000_4.3.e004235.28","first-page":"67","article-title":"Frequency of healthcare visits and glycemic\/blood pressure outcomes among adults with hypertension and diabetes in Tigray","volume":"58","author":"Woldeyohannes","year":"2020","journal-title":"Ethiop Med J"},{"key":"2026073104050510000_4.3.e004235.29","article-title":"Urban-rural disparities in treatment adherence for non-communicable diseases in Ethiopia","volume":"15","author":"Mekonnen","year":"2020","journal-title":"PLoS ONE"},{"key":"2026073104050510000_4.3.e004235.30","first-page":"710","article-title":"The role of social support on chronic disease management in Ethiopia","volume":"19","author":"Mulugeta","year":"2019","journal-title":"BMC Health Serv Res"},{"key":"2026073104050510000_4.3.e004235.31","first-page":"115","article-title":"Impact of khat chewing on blood pressure and glycemic control in northern Ethiopia","volume":"10","author":"Gebreyesus","year":"2019","journal-title":"J Public Health Afr"}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2025-004235","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T11:05:12Z","timestamp":1785495912000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2025-004235"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":31,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,7,31]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/bmjph-2025-004235"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2025-004235","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}