Hypertension prevalence and risk factors among residents of four slum communities

Tymejczyk, Olga; McNairy, Margaret L.; Petion, Jacky S.; Rivera, Vanessa; Dorélien, Audrey; Peck, Mireille; Seo, Grace; Walsh, Kathleen F.; Fitzgerald, Daniel W.; Peck, Robert; Joshi, Ashish; Pape, Jean William; Nash, Denis

doi:10.1097/hjh.0000000000001966

Cited by 27 publications

(44 citation statements)

References 56 publications

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“…For example, age-standardized hypertension prevalence was 18% among a random sample of adults residing in two slums in Kenya [44], 21% (not age adjusted) in a slum study in Brazil [46], and 17-23% among adults living in slums in India [47]. Detailed analysis of hypertension findings from this survey including risk factors associated with hypertension has been previously reported [22]. Interestingly, the traditional risk factors for hypertension such as obesity, diabetes, and smoking were low in our survey-10%, 7%, and 1%, respectively.…”

Section: Discussionmentioning

confidence: 97%

“…At the end of the survey, anthropometrics (height, weight with body mass index (BMI) (kilograms/m 2 )) and blood pressure were collected by the CHW. Blood pressure was measured three times on the left arm using an electronic cuff with 3 cuff sizes (Panasonic model EW3109W) after each participant was seated for a minimum of 15 min [21,22].…”

Section: Data Collectionmentioning

confidence: 99%

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High Burden of Non-communicable Diseases among a Young Slum Population in Haiti

et al. 2019

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The objective of this study was to characterize the demographics and population health of four slum communities in Port-au-Prince, Haiti, including population density and the burden of communicable and non-communicable diseases. Four urban slums were surveyed using a population-representative design between July and October 2016. A multistage cluster area random sampling process was used to identify households and individuals for the survey. Household surveys included rosters of residents, household characteristics, adult and child deaths in the past year, child health, and healthcare access and utilization. Individual surveys of two randomly sam-pl ed adults f rom each household incl uded sociodemographic data, maternal health, and adult health. Additionally, blood pressure, height, weight, and psychological distress were measured by study staff. Data were weighted for complex survey design and non-response. A total of 525 households and 894 individuals completed the survey (96% household and 90% individual response rate, respectively). The estimated population density was 58,000 persons/km 2. Across slums, 55% of all residents were female, and 38% were adolescents and youth 10-24 years. Among adults, 58% were female with median age 29 years (22-38). The most common adult illnesses were severe psychological distress (24%), hypertension (20%), history of physical injury/ trauma (10%), asthma (7%), history of cholera (4%), and history of tuberculosis (3%). Ten percent of adults had obesity (BMI > 30 kg/m 2), and 7% currently smoked. The most common under-5 diseases during the last 3 months were respiratory and gastrointestinal illnesses (50% and 28%, respectively). One-third of households reported needing medical care for a child in the past year but not being able to access it, largely due to financial constraints. Unique features of these slums are a population structure dominated by adolescents and youth, a high proportion of females, and a high burden of noncommunicable diseases including hypertension and psychological distress. Screening, diagnostic, and disease management interventions are urgently needed to protect and promote improved population health outcomes in these slum communities.

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Section: Discussionmentioning

confidence: 97%

Section: Data Collectionmentioning

confidence: 99%

High Burden of Non-communicable Diseases among a Young Slum Population in Haiti

et al. 2019

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“…The sample size is 3000 participants. Based on our prior work, we assumed a 96% household response rate and 91% of households having at least 2 adults available for study participation [ 16 , 17 ]. We anticipate needing to identify and recruit from approximately 1963 households across 2045 GPS points.…”

Section: Methodsmentioning

confidence: 99%

“…More recently, Haiti’s 2017 Demographic Health Survey (DHS) revealed that HTN was the most common CVD risk factor in Haiti with a prevalence of 49% in women and 38% in men ages 35 to 64 [ 15 ]. Our data from a smaller community-based survey of slum residents in Port-au-Prince (PAP) in 2016 found the prevalence of HTN among young Haitians was higher than similar aged Blacks in the US from historical cohort studies [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

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The Haiti cardiovascular disease cohort: study protocol for a population-based longitudinal cohort

Lookens¹,

Tymejczyk²,

Rouzier³

et al. 2020

BMC Public Health

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Background Cardiovascular disease (CVD) is the leading cause of mortality among Haitians, having surpassed HIV in the last decade. Understanding the natural history of CVD in Haitians, including the age of onset, prevalence, incidence, and role of major risk factors and social determinants, is urgently needed to develop prevention and treatment interventions. Aim 1: Establish a population-based cohort of 3000 adults from Port-au-Prince and assess the prevalence of CVD risk factors and diseases and their association with social and environmental determinants. Aim 2: Determine the incidence of CVD risk factors and CVD during 2–3.5 years of follow-up and their association with social and environmental determinants. Methods The Haiti CVD Cohort is a longitudinal observational study of 3000 adults > 18 years in Port-au-Prince (PAP), Haiti. The study population is recruited using multistage random sampling from census blocks. Adults receive blood pressure (BP) measurements in the community and those with elevated BP are referred to the Groupe Haitien d’Etude Sarcome de Kaposi et des Infections Opportunistes Clinic for care. After informed consent, participants undergo a clinical exam with medical history. BP, electrocardiogram, echocardiogram, a study questionnaire on health behaviors, and laboratory specimens. Every 6 months, BP is remeasured. At 12 and 24 months, clinical exams and questionnaires are repeated. Labs are repeated at 24 months. Adjudicated study outcomes include the prevalence and incidence of CVD risk factors (hypertension, diabetes, obesity, dyslipidemia, kidney disease, inflammation, poor diet, smoking, and physical inactivity) and events (myocardial infarction, heart failure, stroke, and CVD mortality). We also measure social determinants including poverty. Depression, stress, social isolation, food insecurity, and lead exposure. Blood, urine, and stool samples are biobanked at study enrollment. Discussion The Haiti CVD Cohort is the largest population-based cohort study evaluating CVD risk factors and CVD among adults in urban Haiti with the goal of understanding the drivers of the CVD epidemic in Haiti. Study outcomes are comparable with existing international cohorts, and the biobank will provide important data for future research. Our goal is to translate findings from this study into pragmatic prevention and treatment interventions to fight the CVD epidemic in Haiti.

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Neighborhood Social Vulnerability and Premature Cardiovascular Disease in Haiti

Roberts,

Sufra,

Yan

et al. 2024

JAMA Cardiol

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ImportanceHigher social vulnerability is associated with premature cardiovascular disease (CVD) and mortality but is understudied in low-income countries that have both the highest magnitude of social vulnerability and a growing CVD epidemic.ObjectiveTo evaluate the association between social vulnerability and hypertension, CVD, and CVD subtypes in Haiti as a model for similar low-income countries.Design, Setting, and ParticipantsThis population-based cohort study used enrollment data from adults participating in the Haiti Cardiovascular Disease Cohort Study. Recruitment occurred via multistage random sampling throughout slum and urban neighborhoods in Port-au-Prince, Haiti, from March 2019 to August 2021. Data were analyzed from May 2022 to December 2023.ExposuresA modified Haitian Social Vulnerability Index (SVI-H) was created following the US Centers for Disease Control and Prevention Social Vulnerability Index method. Twelve variables across the domains of socioeconomic status, household characteristics, and social and community context were included. The SVI-H was calculated for each study neighborhood block and then stratified into SVI-H quartiles (quartile 1 was the least vulnerable; quartile 4, the most vulnerable).Main Outcomes and MeasuresPrevalent hypertension and total CVD, defined as heart failure (HF), stroke, transient ischemic attack (TIA), angina, or myocardial infarction (MI). Age-adjusted Poisson regression analysis yielded prevalence ratios (PRs) comparing the prevalence of hypertension, total CVD, and CVD subtypes across SVI-H quartiles.ResultsAmong 2925 adults (1704 [58.3%] female; mean [SD] age, 41.9 [15.9] years), the prevalence of hypertension was 32.8% (95% CI, 31.1%-34.5%) and the prevalence of CVD was 14.7% (95% CI, 13.5%-16.0%). Hypertension prevalence ranged from 26.2% (95% CI, 23.1%-29.3%) to 38.4% (95% CI, 34.8%-42.0%) between quartiles 1 and 4, while CVD prevalence ranged from 11.1% (95% CI, 8.8%-13.3%) to 19.7% (95% CI, 16.8%-22.6%). SVI-H quartile 4 vs 1 was associated with a greater prevalence of hypertension (PR, 1.17; 95% CI, 1.02-1.34) and CVD (PR, 1.48; 95% CI, 1.16-1.89). Among CVD subtypes, SVI-H was significantly associated with HF (PR, 1.64; 95% CI, 1.23-2.18) but not with combined stroke and TIA or combined angina and MI.Conclusions and RelevanceIn urban Haiti, individuals living in neighborhoods with the highest social vulnerability had greater prevalence of hypertension and HF. Understanding CVD disparities in low-income countries is essential for targeting prevention and treatment interventions toward populations at highest risk globally.

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Hypertension prevalence and risk factors among residents of four slum communities

Cited by 27 publications

References 56 publications

High Burden of Non-communicable Diseases among a Young Slum Population in Haiti

High Burden of Non-communicable Diseases among a Young Slum Population in Haiti

The Haiti cardiovascular disease cohort: study protocol for a population-based longitudinal cohort

Neighborhood Social Vulnerability and Premature Cardiovascular Disease in Haiti

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