Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
J Glob Health. 2022 Feb 26;12:04020. doi: 10.7189/jogh.12.04020. eCollection 2022.
Sex and gender-based differences in cardiovascular health (CVH) has been explored in the context of high-income countries. However, these relationships have not been examined in low- and middle-income countries. The main aim of this study was to examine how sex and gender-related factors are associated with cardiovascular risk factors of people in South Asian countries.
We conducted a retrospective analysis of the World Health Organization's "STEPwise approach to surveillance of risk factors for non-communicable disease" or "STEPS" from six South Asian countries, surveys conducted between 2014-2019. The main outcomes were CVH as measured by a composite measure of STEPS-HEART health index (smoking, physical activity, fruit and vegetable consumption, overweight/obesity, diabetes and hypertension), values ranging from 0 (worst) to 6 (best or ideal) and self-reported occurrence of cardiovascular disease (ie, heart attack and stroke). Multivariate linear and logistic regression models were performed. Multiple imputation with chained equations was performed.
The final analytic sample consisted of 33 106 participants (57.5% females). The mean STEPS-HEART index score in the South Asian population was 3.43 [SD: 0.92]. Female sex (β: 0.05, 95% confidence interval (CI) = 0.01-0.08, < 0.05) was significantly associated with better CVH compared to males. Being married (β = -0.30, 95% CI = -0.37, -0.23 vs β = -0.23, 95% CI = -0.29, -0.17; < 0.001) and having a household size ≥5 (β = -0.15, 95% CI = -0.24, -0.06 vs β = -0.11, 95% CI = -0.16, -0.04; < 0.01) were associated with poorer CVH, more so in males. Being married was also associated with high risk of CVD (OR = 2.54, 95% CI = 1.68-3.86, < 0.001 vs OR = 1.19, 95% CI = 0.84-1.68, = 0.31), significant in males.
Among the South Asian population, being female may be advantageous in having an ideal CVH. However, gender-related factors such as marital status and large household size were associated with poorer CVH and greater risk of CVD, regardless of sex.
在高收入国家的背景下，已经探讨了心血管健康（CVH）中的性别和基于性别的差异。然而，这些关系尚未在中低收入国家进行检查。本研究的主要目的是研究与南亚国家人群心血管风险因素相关的性别和与性别相关的因素。
我们对世界卫生组织的“逐步监测非传染性疾病危险因素的方法”或“ STEPS”进行了回顾性分析，该方法来自六个南亚国家，调查于 2014 年至 2019 年之间进行。主要结局是 CVH，通过 STEPS-HEART 健康指数（吸烟，体力活动，水果和蔬菜摄入，超重/肥胖，糖尿病和高血压）的综合衡量来衡量，值范围为 0（最差）至 6（最佳或理想），以及自我报告的心血管疾病（即心脏病发作和中风）的发生。进行了多元线性和逻辑回归模型分析。使用链式方程进行了多重插补。
最终的分析样本包括 33106 名参与者（57.5％为女性）。南亚人群的 STEPS-HEART 指数平均得分为 3.43[SD：0.92]。与男性相比，女性（β：0.05，95％CI=0.01-0.08， < 0.05）的性别与更好的 CVH 显著相关。已婚（β= -0.30，95％CI= -0.37，-0.23 vs β= -0.23，95％CI= -0.29，-0.17； < 0.001）和家庭规模≥5（β= -0.15，95％CI= -0.24，-0.06 vs β= -0.11，95％CI= -0.16，-0.04； < 0.01）与较差的 CVH 相关，对男性的影响更大。已婚也与 CVD 的高风险相关（OR= 2.54，95％CI= 1.68-3.86， < 0.001 vs OR= 1.19，95％CI= 0.84-1.68， = 0.31），在男性中更为明显。
在南亚人群中，女性可能具有理想的 CVH 优势。然而，与性别相关的因素（例如婚姻状况和大家庭规模）与较差的 CVH 和更高的 CVD 风险相关，而与性别无关。
