Sex and Gender Influence on Cardiovascular Health in Sub-Saharan Africa: Findings from Ghana, Gambia, Mali, Guinea, and Botswana
Rubee Dev,
Divine Favour-Ofili,
Valeria Raparelli,
Hassan Behlouli,
Zahra Azizi,
Karolina Kublickiene,
Alexandra Kautzky-Willer,
Maria Trinidad Herrero,
Louise Pilote,
Colleen M. Norris,
on behalf of the GOING-FWD Consortium
Affiliations
Rubee Dev
Faculty of Applied Science, School of Nursing, University of British Columbia, Vancouver
Divine Favour-Ofili
Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec
Valeria Raparelli
Faculty of Nursing, University of Alberta, Edmonton, Alberta, CA; Department of Translational Medicine, University of Ferrara, Ferrara; University Center for Studies on Gender Medicine, University of Ferrara, Ferrara
Hassan Behlouli
Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec
Zahra Azizi
Research Institute of McGill University Health Centre, Division of Clinical Epidemiology McGill University, Montreal, Quebec; Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, QC
Karolina Kublickiene
Department of Clinical intervention, Science and Technology (CLINTEC), Section for Renal Medicine, Karolinska Institute and Karolinska University hospital, Stockholm
Alexandra Kautzky-Willer
Department of Internal Medicine III, Division of Endocrinology and Metabolism, Gender Medicine Unit, Medical University of Vienna, Vienna
Maria Trinidad Herrero
Clinical & Experimental Neuroscience (NiCE-IMIB-IUIE), School of Medicine. University of Murcia, Murcia
Louise Pilote
Research Institute of McGill University Health Centre, Division of Clinical Epidemiology McGill University, Montreal, Quebec; Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, QC
Colleen M. Norris
Faculty of Nursing, University of Alberta, Edmonton, Alberta; Faculty of Medicine and Dentistry and School of Public Health, University of Alberta, Edmonton, Alberta
Background: There is an upsurge of cardiovascular diseases (CVDs) in sub-Saharan Africa (SSA). Irrespective of biological sex, gender-related factors could be the precursor of these conditions. Objective: To examine the associations between biological sex, gender-related variables, and cardiovascular health (CVH) risk factors in SSA countries. Methods: We used data from the STEPwise approach to surveillance of risk factors for non-communicable disease survey, conducted in adults from Ghana, Gambia, Mali, Guinea, and Botswana. The main outcome was CVH, measured through the health index with values ranging from 0 (worst) to 5 (best or ideal) CVH. Multivariable logistic regression was applied to determine the gender-related factors related to poorer CVH (index less than 4). Results: Data included 15,356 adults (61.4% females, mean age 36.9 years). The prevalence of hypertension (21.6% vs. 13.8%) and overweight/obesity (48.3% vs. 27.5%) was higher among females as compared to males. Females were more likely to be unemployed (17.3% vs. 9.7%) or reported unpaid work (36.8% vs. 15.2%). Overall, females showed worse CVH than males (ORfemale = 0.95, 95% CI:0.91–0.99). Being married was associated with better CVH compared with being single, more so for males (ORmale = 1.09, 95% CI:0.96–1.24, pinteraction < 0.01). Males with unpaid work (ORmale = 1.28, 95% CI:1.12–1.47) had better CVH than their unpaid female counterparts (ORfemale = 1.08, 95% CI:1.01–1.17). Conclusion: In SSA populations, being female was associated with poorer CVH given the disproportionate burden of hypertension and overweight/obesity. Gender-related factors such as marital status and unpaid work were associated with better CVH in males compared to females.
