Sujarwoto Sujarwoto, Maharani Asri, Praveen Devarsetty, Palagyi Anna, Kumar Prem S G, Abimbola Seye, Tampubolon Gindo, Patel Anushka
Department of Public Administration, University of Brawijaya, Malang, Indonesia.
Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre (MAHSC), Manchester, United Kingdom.
PLoS One. 2025 Aug 20;20(8):e0318112. doi: 10.1371/journal.pone.0318112. eCollection 2025.
Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality in Indonesia. Despite the importance of identifying individuals at high risk of CVDs for Indonesian health planners in designing effective intervention strategies, the CVD situation in the country has not been well-documented. This study aimed to estimate the distribution of the estimated 10-year risk of CVD and the associated socio-demographic factors and healthcare access in Indonesia.
This study was a community-based study in which the data were collected using interviews and the taking of physical measurements of 903,130 adults aged 40 years and older in 390 villages in Malang District, East Java Province, Indonesia, from January 2020 to February 2024. The estimated 10-year risk of CVD was calculated based on the World Health Organization/International Society of Hypertension's region-specific charts for the Southeast Asia Region (SEAR B). We performed multilevel logistic regression modelling to examine the associations between individual and healthcare provider densities and the estimated 10-year risk of CVD, as well as receiving optimal preventive treatment, defined as at least one blood pressure-lowering drug and a statin for all high-risk individuals, and an antiplatelet drug for those with prior diagnosed CVD.
Among 903,130 participants, 169,758 (18.8%; 95% Confidence Intervals 18.7% - 18.9%) had high cardiovascular risk. The proportion of high CVD risk was greater (<0.001) in urban (19.6%) than in rural areas (18.3%). Only 25.7% of all the respondents with high CVD risk received optimal preventive treatment, with high-risk males who live in urban areas showing better treatment. The availability of community-based health care (Posbindu), medical doctor at primary healthcare, nurses, and health insurance were associated with lower odds of having high CVD risk.
Around one-fifth of the population aged 40+ in Malang District, Indonesia is estimated to have high 10-year CVD risks, as assessed by the WHO/ISH risk prediction charts, and three-quarters of those with high risk did not receive optimal preventive treatment. Ensuring that individuals with high CVD risk get the optimal treatment is important, especially in low- and middle-income countries. The accessibility of preventive care is vital in primary care to address the sex and geographical gap of CVD risk management.
心血管疾病（CVDs）是印度尼西亚发病和死亡的主要原因。尽管识别心血管疾病高风险个体对于印度尼西亚的卫生规划者制定有效的干预策略很重要，但该国的心血管疾病情况尚未得到充分记录。本研究旨在估计印度尼西亚心血管疾病估计10年风险的分布以及相关的社会人口因素和医疗保健可及性。
本研究是一项基于社区的研究，于2020年1月至2024年2月在印度尼西亚东爪哇省玛琅区的390个村庄，通过访谈和对903,130名40岁及以上成年人进行身体测量来收集数据。心血管疾病的估计10年风险是根据世界卫生组织/国际高血压学会针对东南亚地区（SEAR B）的特定区域图表计算得出的。我们进行了多水平逻辑回归建模，以研究个体和医疗保健提供者密度与心血管疾病估计10年风险之间的关联，以及接受最佳预防性治疗的情况，最佳预防性治疗定义为所有高风险个体至少使用一种降压药物和一种他汀类药物，对于先前诊断为心血管疾病的个体使用抗血小板药物。
在903,130名参与者中，169,758人（18.8%；95%置信区间18.7% - 18.9%）有高心血管风险。城市地区（19.6%）的高心血管疾病风险比例高于农村地区（18.3%）（<0.001）。所有心血管疾病高风险受访者中只有25.7%接受了最佳预防性治疗，居住在城市地区的高风险男性接受治疗情况更好。基于社区的医疗保健（Posbindu）、初级医疗保健机构的医生、护士和医疗保险的可及性与心血管疾病高风险几率较低相关。
根据世界卫生组织/国际高血压学会风险预测图表评估，印度尼西亚玛琅区约五分之一的40岁及以上人口估计有高10年心血管疾病风险，四分之三的高风险人群未接受最佳预防性治疗。确保心血管疾病高风险个体获得最佳治疗很重要，尤其是在低收入和中等收入国家。预防性护理的可及性对于初级保健中解决心血管疾病风险管理的性别和地理差距至关重要。
