Prevalence and Associated Risk Factors of Diabetes, Chronic Kidney Disease, and Hypertension of Adults in the Peruvian Amazon: The Amarakaeri Reserve Cohort Study

Background: The Peruvian Amazon is in the midst of an epidemiological transition. Large urban population centers are growing rapidly, with non-communicable diseases (NCDs) beginning to outpace incidence of infectious diseases. However, in rural and semi-urban environments, population-level NCD burdens remain poorly defined. Methods: In 2015 we conducted a cross-sectional study of randomly selected adults in indigenous, rural, and semi-urban communities surrounding the Amarakaeri Communal Reserve (ACR) in the southern Amazon region of Peru. We estimated disease prevalence and identified risk factors for several NCDs, including diabetes, chronic kidney disease (CKD), and hypertension. Findings: We surveyed 2,268 adults from 1,122 households. Disease prevalence for men was 1·7% for diabetes, 10·2% for CKD, 7·0% for hypertension, and 18·7% for any NCD (diabetes, CKD, or hypertension). Prevalence for women was 2·5% for diabetes, 3·3% for CKD, 1·8% for hypertension, and 7·3% for any NCD. Among adults with diabetes or hypertension, only 31% and 19% were aware of their disease status, respectively. No cases of diabetes were found in indigenous communities. Age was a risk factor for each NCD outcome, physical inactivity was a risk factor for diabetes, and male sex and education were risk factors for hypertension. Interpretation: The ACR in the Peruvian Amazon has a high NCD burden, with disparities observed by sex and indigenous status. Risk factors identified indicate that disease burden may increase with age and its associated cardiovascular impacts. As many of these risk factors are modifiable, early interventions that address these issues will provide a better chance to slow, stop, or even reverse the installation of larger disease burdens. Funding Statement: Duke Global Health Institute, Duke University Center for International Studies (DUCIS), and Hunt Oil, LLC. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Approval for this study was obtained from the Institutional Review Board of the Universidad Peruana Cayetano Heredia and informed consent was obtained from all adult participants.