Data from: Cardiovascular disease risk factors in Ghana during the rural-to-urban transition: a cross-sectional study

Populations in sub-Saharan Africa are shifting from rural to increasingly urban. Although the burden of cardiovascular disease is expected to increase with this changing landscape, few large studies have assessed a wide range of risk factors in urban and rural populations, particularly in West Africa. We conducted a cross-sectional, population-based survey of 3317 participants from Ghana (≥18 years old), of whom 2265 (57% female) were from a mid-sized city (Sunyani, population ~250,000) and 1052 (55% female) were from surrounding villages (populations <5000). We measured canonical cardiovascular disease risk factors (BMI, blood pressure, fasting glucose, lipids) and fibrinolytic markers (PAI-1 and t-PA), and assessed how their distributions and related clinical outcomes (including obesity, hypertension and diabetes) varied with urban residence and sex. Urban residence was strongly associated with obesity (OR: 7.8, 95% CI: 5.3–11.3), diabetes (OR 3.6, 95% CI: 2.3–5.7), and hypertension (OR 3.2, 95% CI: 2.6–4.0). Among the quantitative measures, most affected were total cholesterol (+0.81 standard deviations, 95% CI 0.73–0.88), LDL cholesterol (+0.89, 95% CI: 0.79–0.99), and t-PA (+0.56, 95% CI: 0.48–0.63). Triglycerides and HDL cholesterol profiles were similarly poor in both urban and rural environments, but significantly worse among rural participants after BMI-adjustment. For most of the risk factors, the strength of the association with urban residence did not vary with sex. Obesity was a major exception, with urban women at particularly high risk (26% age-standardized prevalence) compared to urban men (7%). Overall, urban residents had substantially worse cardiovascular risk profiles, with some risk factors at levels typically seen in the developed world.

撒哈拉以南非洲的人口正从农村向城市化快速转型。尽管伴随这一人口结构变迁，心血管疾病的疾病负担预计将随之上升，但目前鲜有大型研究对城乡人群的广泛风险因素开展评估，尤其在西非地区。本研究针对加纳3317名年满18周岁的受试者开展了基于人群的横断面（cross-sectional）调查，其中2265名受试者（女性占比57%）来自中等规模城市苏尼尼（Sunyani，人口约25万），剩余1052名受试者（女性占比55%）来自周边人口不足5000的乡村。本研究测定了经典心血管疾病风险因素，包括体重指数（Body Mass Index, BMI）、血压、空腹血糖、血脂，以及纤溶标志物：纤溶酶原激活物抑制剂-1（Plasminogen Activator Inhibitor-1, PAI-1）与组织型纤溶酶原激活物（Tissue-type Plasminogen Activator, t-PA）；同时分析了这些指标的分布特征，及其相关临床结局（涵盖肥胖、高血压与糖尿病）如何随城乡居住环境与性别发生变化。城乡居住环境与肥胖（比值比（odds ratio, OR）：7.8，95%置信区间（confidence interval, CI）：5.3~11.3）、糖尿病（OR=3.6，95%CI：2.3~5.7）及高血压（OR=3.2，95%CI：2.6~4.0）均存在显著正相关关联。在定量检测指标中，受城乡差异影响最为显著的分别为总胆固醇（升高0.81个标准差，95%CI：0.73~0.88）、低密度脂蛋白胆固醇（Low-Density Lipoprotein Cholesterol, LDL-C，升高0.89，95%CI：0.79~0.99）以及t-PA（升高0.56，95%CI：0.48~0.63）。甘油三酯与高密度脂蛋白胆固醇（High-Density Lipoprotein Cholesterol, HDL-C）的异常表现在城乡人群中均较为普遍，但在校正BMI后，乡村受试者的上述指标异常程度显著更严重。对于多数风险因素而言，其与城乡居住环境的关联强度并未随性别产生显著差异。肥胖则是主要的例外：城市女性的肥胖风险尤其突出，其年龄标化患病率达26%，而城市男性的肥胖患病率仅为7%。总体而言，城市居民的心血管风险谱显著更差，部分风险因素的水平已达到发达国家的典型水平。