Title: Cardiovascular Disease Risk Factors in Ghana during the Rural-to-Urban Transition: A Cross-Sectional Study.
Authors: Kodaman, Nuri; Aldrich, Melinda C; Sobota, Rafal; Asselbergs, Folkert W; Poku, Kwabena A; Brown, Nancy J; Moore, Jason H; Williams, Scott M
Published In PLoS One, (2016)
Abstract: Populations in sub-Saharan Africa are shifting from rural to increasingly urban. Although the burden of cardiovascular disease is expected to increase with this changing landscape, few large studies have assessed a wide range of risk factors in urban and rural populations, particularly in West Africa. We conducted a cross-sectional, population-based survey of 3317 participants from Ghana (≥18 years old), of whom 2265 (57% female) were from a mid-sized city (Sunyani, population ~250,000) and 1052 (55% female) were from surrounding villages (populations <5000). We measured canonical cardiovascular disease risk factors (BMI, blood pressure, fasting glucose, lipids) and fibrinolytic markers (PAI-1 and t-PA), and assessed how their distributions and related clinical outcomes (including obesity, hypertension and diabetes) varied with urban residence and sex. Urban residence was strongly associated with obesity (OR: 7.8, 95% CI: 5.3-11.3), diabetes (OR 3.6, 95% CI: 2.3-5.7), and hypertension (OR 3.2, 95% CI: 2.6-4.0). Among the quantitative measures, most affected were total cholesterol (+0.81 standard deviations, 95% CI 0.73-0.88), LDL cholesterol (+0.89, 95% CI: 0.79-0.99), and t-PA (+0.56, 95% CI: 0.48-0.63). Triglycerides and HDL cholesterol profiles were similarly poor in both urban and rural environments, but significantly worse among rural participants after BMI-adjustment. For most of the risk factors, the strength of the association with urban residence did not vary with sex. Obesity was a major exception, with urban women at particularly high risk (26% age-standardized prevalence) compared to urban men (7%). Overall, urban residents had substantially worse cardiovascular risk profiles, with some risk factors at levels typically seen in the developed world.
PubMed ID: 27732601
MeSH Terms: Adolescent; Adult; Aged; Aged, 80 and over; Blood Glucose/analysis; Blood Pressure; Body Mass Index; Cardiovascular Diseases/epidemiology; Cardiovascular Diseases/etiology*; Cholesterol, HDL/blood; Cholesterol, LDL/blood; Cholesterol/blood; Cross-Sectional Studies; Diabetes Mellitus, Type 2/complications; Diabetes Mellitus, Type 2/epidemiology; Female; Ghana/epidemiology; Humans; Hypertension/complications; Hypertension/epidemiology; Male; Middle Aged; Obesity/complications; Obesity/epidemiology; Plasminogen Activator Inhibitor 1/blood; Prevalence; Risk Factors; Smoking; Surveys and Questionnaires; Tissue Plasminogen Activator/blood; Triglycerides/blood; Urbanization*; Young Adult