Vusirikala Amoolya, Wekesah Frederick, Kyobutungi Catherine, Oyebode Oyinlola
University of Warwick Warwick Medical School, Coventry, UK
African Population and Health Research Center, Nairobi, Kenya.
BMJ Open. 2019 Sep 4;9(9):e029304. doi: 10.1136/bmjopen-2019-029304.
Although cardiovascular disease (CVD) is of growing importance in low- and middle-income countries (LMICs), there are conflicting views regarding CVD as a major public health problem for the urban poor, including those living in slums. We examine multivariable risk prediction in a slum population and assess the number of cardiovascular related deaths within 10 years of application of the tool.
We use data from the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) population (residents of two slum communities) between May 2008 and April 2009.
This is a secondary data analysis from a cross-sectional survey. We use the WHO/International Society of Hypertension (WHO/ISH) cardiovascular risk prediction tool to examine 10-year risk of major CVD events in a slum population. CVD deaths in the cohort, reported up until June 2018 and identified through verbal autopsy are also presented.
3063 men and women aged over 40 years with complete data for variables needed for the WHO/ISH risk prediction tool were eligible to take part.
The majority of study members (2895, 94.5%) were predicted to have 'low' risk (<10%) of a cardiovascular event over the next 10 years and just 51 (1.7%) to have 'high' CVD risk (≥20%). 91 CVD deaths were reported for the cohort up until June 2018. Of individuals classified as low risk, 74 (2.6%) were identified as having died of CVD. Nine (7.7%) individuals classified at 10% to 20% risk and eight (15.9%) classified at >20% were identified as dying of CVD.
This study shows that there is a low risk profile of CVD in this slum population in Nairobi, Kenya, in comparison to results from application of multivariable risk prediction tools in other LMIC populations. This has implications for health service planning in these contexts.
尽管心血管疾病（CVD）在低收入和中等收入国家（LMICs）中的重要性日益增加，但对于CVD是否是城市贫困人口（包括居住在贫民窟的人群）的主要公共卫生问题，存在相互矛盾的观点。我们研究了贫民窟人群的多变量风险预测，并评估了该工具应用10年内心血管相关死亡的数量。
我们使用了2008年5月至2009年4月内罗毕城市卫生和人口监测系统（NUHDSS）人群（两个贫民窟社区的居民）的数据。
这是一项横断面调查的二次数据分析。我们使用世界卫生组织/国际高血压学会（WHO/ISH）心血管风险预测工具来研究贫民窟人群中主要CVD事件的10年风险。还呈现了该队列中截至2018年6月报告的、通过口头尸检确定的CVD死亡情况。
3063名年龄在40岁以上、具备WHO/ISH风险预测工具所需变量完整数据的男性和女性有资格参与。
大多数研究成员（2895名，94.5%）预计在未来10年内发生心血管事件的风险为“低”（<10%），只有51名（1.7%）有“高”CVD风险（≥20%）。截至2018年6月，该队列报告了91例CVD死亡。在被归类为低风险的个体中，74名（2.6%）被确定死于CVD。9名（7.7%）风险分类为10%至20%的个体和8名（15.9%）风险分类>20%的个体被确定死于CVD。
本研究表明，与在其他低收入和中等收入国家人群中应用多变量风险预测工具的结果相比，肯尼亚内罗毕的这个贫民窟人群中CVD风险较低。这对这些情况下的卫生服务规划具有启示意义。
