Elsevier

Public Health

Volume 137, August 2016, Pages 73-80
Public Health

Original Research
Cardiovascular risk assessment among rural population: findings from a cohort study in a peripheral region of Bangladesh

https://doi.org/10.1016/j.puhe.2016.02.016Get rights and content

Highlights

  • Bangladeshis are prone to develop CVDs and the prevalence of the diseases among them are increasing rapidly.

  • Ageing, higher socioeconomic status, smoking, hypertension, and diabetes are major risk factors for CVDs among urbanizing rural population.

  • Using the WHO multiple risk factor assessment tool, the prevalence of high CVD risk individuals is low among a peripherally located rural Bangladeshi population.

  • The prevalence of age, obesity, smoking and hypertension are low among a peripherally located rural Bangladeshi population.

  • The level of urbanization should be carefully considered when analysing CVD risk factors in a specific study population.

Abstract

Objectives

The incidences of non-communicable diseases including cardiovascular diseases (CVDs) is increasing in Bangladesh. The reasons for this increasing trend need to be explored. The aim of this study is to assess the risk of CVDs among a peripheral rural Bangladeshi population and to explore the sociodemographic, anthropometric and clinical variables associated with increased risk.

Study design

Cohort study.

Methods

From a cohort of 190,471 individuals of all ages, originally included in a diabetic eye disease program initiated in 2008–2009, a purposive sub-cohort of 66,710 individuals, aged 31–74 years was recruited. During 2011–2012 these participants were assessed for CVDs using the WHO's risk assessment tool designed for primary care settings in low resource societies. Participant characteristics associated with higher risk were explored using univariable and multivariable regression analysis.

Results

Out of all (95.5% participation rate) participants 1170 (1.84%) were found to be at high risk for CVD. The prevalence of hypertension (HTN), pre-HTN, obesity, underweight and self-reported DM were 8.9%, 15.2%, 9.6%, 7.8% and 0.5% respectively, among the study population. In multivariable regression analysis female sex, older age, temporary housing structure (i.e., tin shed), extremes of BMI (both underweight and obese) and central obesity were associated with higher risk for CVDs.

Conclusions

The prevalence of CVD risk factors and high CVD risk individuals in this cohort was found to be lower than previous studies. It may be the effects of urbanization are yet to reach this relatively traditional rural population. This study adds to the literature on use of the WHO risk assessment tool.

Introduction

Non-communicable diseases (NCDs) are now major public health problems in both developed as well as low- and middle-income countries (LMICs).1 While death rates from cardiovascular diseases (CVDs) have been declining in developed countries the prevalence of CVDs has been rising greatly in LMICs.2 At the beginning of the present millennium 80% of the burden of CVDs was estimated to occur in these countries.3 South Asians exhibit greater susceptibility to these diseases4 and compared to the western population CVD-related death among South Asian populations has been found to occur 5–10 years earlier.5 This increased susceptibility to CVD among South Asian populations is not fully explained by traditional risk factors.2

Although some useful information has been generated on the present and future burden of CVDs in Bangladesh, organized epidemiological studies exploring the prevalence of CVDs as well as their risk factors among various groups and subgroups of the population are relatively scarce. Evidence suggests that CVD risk prediction based on the combined effect of multiple risk factors is more accurate than that based on individual risk factors.6 There are few studies on Bangladeshi population using multiple risk assessment approach for coronary heart disease (CHD) or CVDs as a whole. Moreover, the majority of studies to date were conducted either on Bangladeshi migrants (along with some other Asian ones) or on subjects recruited from tertiary hospital settings.7, 8, 9, 10 Only two studies, so far, have explored multiple CVD risk factors among the rural Bangladeshi population,11, 12 but the subjects were recruited from areas within 50 km of the capital (Dhaka) and thus, may not reflect the prevalence in peripherally located rural population.

Given the scarcity of population data the present study was undertaken to assess CVD risk factors among members of a large population-based cohort in a more traditional rural setting in a peripheral region of the country (at Pirganj Upazilla of Thakurgaon district, about 467 km north-west of Dhaka) using the WHO Risk Management Package tool for CVDs.13 In this paper, we present the assessment of CVDs risk (using baseline data) in this population.

The association between CVD risk and sociodemographic, anthropometric and clinical characteristics has also been explored.

Section snippets

Study population and data collection procedures

This study was conducted as the baseline survey of a prospective cohort among the rural Bangladeshi population, started in 2008 under the ‘BADAS-ORBIS Eye Care Project’. The original cohort was initiated to generate epidemiological data on the burden of diabetic retinopathy and associated risk factors from a rural population and study area was selected as per that project design. The study was conducted in an upazilla (sub-district) named ‘Pirgonj’ of Thakurgaon district - one of the

Overall characteristics of the study participants

According to the WHO's CVD risk assessment tool, only 1170 (1.84%) of the participants were at high risk for a further CVD event on the basis of pre-existing CVDs (angina, heart attack, stroke and TIA).

Sociodemographic characteristic of all the participants are shown in Table 1. High risk individuals were different from rest of the study participants with respect to gender, age group, education and gross national income (P < 0.001). Among the high risk group a smaller proportion was aged under

Discussion

The present study shows a small number of high risk subjects for CVDs (1.84%) on the basis of a positive finding on the WHO tool in this rural population which is located in a peripheral area of Bangladesh. Older age, female sex, temporary housing structure, underweight and obesity define by BMI and central obesity were associated with being a higher risk for CVD in this population. A few recent studies have also used the WHO tool. In a study among Chinese and Nigerian population, only 2% of

Acknowledgements

We are indebted to all participants in this study. Also acknowledge important contribution of the field workers, Thakurgaon Swasthoseba Hospital and the ORBIS International to make this work possible.

Ethics approval

Human Research Ethical Committee (HREC) of the University of New South Wales (HREC ref: ≠HC12621), Sydney, Australia and the Ethics Review Committee of the Diabetic Association of Bangladesh (DAB).

Funding

This work was supported by grants from the Bangladesh University of Health Sciences (BUHS).

Competing interests

The authors

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    Project Place: Pirgonj of Thakurgaon district – one of the north-western districts in Bangladesh.

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    Permanent address. Department of Epidemiology, Bangladesh University of Health Sciences (BUHS), 125/1, Darus Salam, Mirpur, Dhaka 1216 Bangladesh. Tel.: +880 2 8055352, +880 1716502930 (mobile); fax: +880 2 8611138.

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