Healthcare access and socio-demographic determinants of estimated 10-year risk of cardiovascular diseases in Indonesia: A population-based study.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.