{
  "abstract": "Background 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.Methods A retrospective cohort study was conducted at Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia. Medical records of 1024 adults (≥18 years) with hypertension and/or T2DM and at least three follow-up visits (December 2022–April 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.Results Participants had a mean age of 49 years and mean body mass index of 27.2 kg/m²; 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<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.Conclusions 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.",
  "authors": [
    {
      "affiliations": [
        "Chief Executive Officer, Alamata General Hospital, Alamata, Ethiopia"
      ],
      "name": "Abdukadir Nigus Mohammed"
    },
    {
      "affiliations": [
        "Medical Director, Lekatit-11 Primary Hospital, Mekelle, Ethiopia"
      ],
      "name": "Edris Abdu Debesay"
    },
    {
      "affiliations": [
        "Public Health, Adigrat University College of Medicine and Health Sciences, Adigrat, Ethiopia"
      ],
      "name": "Ashagire Zenebe Woldearegawi"
    }
  ],
  "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",
  "uid": "419185fa-8f59-5aea-adb8-9803b05f8943"
}