Modifiable risk factors and overall cardiovascular mortality: Moderation of urbanization
Background: Modifiable risk factors are associated with cardiovascular mortality (CVM) which is a leading form of global mortality. However, diverse nature of urbanization and its objective measurement can modify their relationship. This study aims to investigate the moderating role of urbanization in the relationship of combined exposure (CE) of modifiable risk factors and CVM.
Design and Methods: This is the first comprehensive study which considers different forms of urbanization to gauge its manifold impact. Therefore, in addition to existing original quantitative form and traditional two categories of urbanization, a new form consisted of four levels of urbanization was duly introduced. This study used data of 129 countries mainly retrieved from a WHO report, Non-Communicable Diseases Country Profile 2014. Factor scores obtained through confirmatory factor analysis were used to compute the CE. Age-income adjusted regression model for CVM was tested as a baseline with three bootstrap regression models developed for the three forms of urbanization.
Results: Results revealed that the CE and CVM baseline relationship was significantly moderated through the original quantitative form of urbanization. Contrarily, the two traditional categories of urbanization could not capture the moderating impact. However, the four levels of urbanization were objectively estimated the urbanization impact and subsequently indicated that the CE was more alarming in causing the CVM in levels 2 and 3 urbanized countries, mainly from low-middle-income countries.
Conclusion: This study concluded that the urbanization is a strong moderator and it could be gauged effectively through four levels whereas sufficiency of two traditional categories of urbanization is questionable.
2. Patel SA, Winkel M, Ali MK, Narayan KV, Mehta NK. Cardiovascular mortality associated with 5 leading risk factors: national and state preventable fractions estimated from survey data. Ann Intern Med 2015;163:245-53.
3. Sani MU, Wahab KW, Yusuf BO, Gbadamosi M, Johnson OV, Gbadamosi A. Modifiable cardiovascular risk factors among apparently healthy adult Nigerian population-a cross sectional study. BMC Research Notes 2010;3:11.
4. Sliwa K, Acquah L, Gersh BJ, Mocumbi AO. Impact of socioeconomic status, ethnicity, and urbanization on risk factor profiles of cardiovascular disease in Africa. Circulation 2016;133:1199-208.
5. Roth GA, Forouzanfar MH, Moran AE, Barber R, Nguyen G, Feigin VL, et al. Demographic and epidemiologic drivers of global cardiovascular mortality. N Engl J Med 2015;372:1333-41.
6. Vlahov D, Galea S, Gibble E, Freudenberg N. Perspectives on urban conditions and population health. Cad Saude Publica 2005;21:949-57.
7. Allender S, Wickramasinghe K, Goldacre M, Matthews D, Katulanda P. Quantifying urbanization as a risk factor for noncommunicable disease. J Urban Health 2011;88:906.
8. Ramachandran A, Mary S, Yamuna A, Murugesan N, Snehalatha C. High prevalence of diabetes and cardiovascular risk factors associated with urbanization in India. Diabetes Care 2008.
9. Cyril S, Oldroyd JC, Renzaho A. Urbanisation, urbanicity, and health: a systematic review of the reliability and validity of urbanicity scales. BMC public health 2013;13:513.
10. City BL, Assessment E. Urbanization and health. Bull World Health Organ 2010;88:245-46.
11. Kearney J. Food consumption trends and drivers. Philosophical Transactions of the Royal Society of London B: Biological Sciences 2010;365:2793-807.
12. Phelan JC, Link BG, Tehranifar P. Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications. J Health Soc Behav 2010;51:S28-S40.
13. Gong P, Liang S, Carlton EJ, Jiang Q, Wu J, Wang L, et al. Urbanisation and health in China. The Lancet 2012;379:843-52.
14. Organization WH. Noncommunicable Diseases (NCD) Country Profiles, . 2018.
15. Tacoli C, McGranahan G, Satterthwaite D. Urbanisation, rural-urban migration and urban poverty: Human Settlements Group, International Institute for Environment and Development; 2015.
16. Chan F, Adamo S, Coxson P, Goldman L, Gu D, Zhao D, et al. Projected impact of urbanization on cardiovascular disease in China. International journal of public health 2012;57:849-54.
17. Mathenge W, Foster A, Kuper H. Urbanization, ethnicity and cardiovascular risk in a population in transition in Nakuru, Kenya: a population-based survey. BMC public health 2010;10:569.
18. Hugo G. New forms of urbanization: beyond the urban-rural dichotomy: Routledge; 2017.
19. Riha J, Karabarinde A, Ssenyomo G, Allender S, Asiki G, Kamali A, et al. Urbanicity and lifestyle risk factors for cardiometabolic diseases in rural Uganda: a cross-sectional study. PLoS medicine 2014;11:e1001683.
20. Prescott E. Prognostic Factors and Risk Scores in Heart Failure. Current Approach to Heart Failure: Springer; 2016. p. 575-602.
21. DeFilippis AP, Young R, Carrubba CJ, McEvoy JW, Budoff MJ, Blumenthal RS, et al. An analysis of calibration and discrimination among multiple cardiovascular risk scores in a modern multiethnic cohort. Ann Intern Med 2015;162:266-75.
22. Organization WH. Global action plan for the prevention and control of noncommunicable diseases 2013-2020. 2013.
23. Organization WH. Noncommunicable diseases country profiles 2014. 2014 9241507500.
24. Hair JF, Black WC, Babin B, Anderson R, Tatham R. RE : Multivariate Data Analysis. A Global Perspective 2010.
25. Nations U. World urbanization prospects: The 2011 revision. new york: United nations department of economic and social affairs/population division. 2012.
26. Satterthwaite D, McGranahan G, Tacoli C. Urbanization and its implications for food and farming. Philosophical Transactions of the Royal Society B: Biological Sciences 2010;365:2809-20.
27. The World Bank. World Development Indicators Washington, DC: International Bank for Reconstruction and Development/The World Bank 2014.
28. Barquera S, Pedroza-Tobías A, Medina C, Hernández-Barrera L, Bibbins-Domingo K, Lozano R, et al. Global overview of the epidemiology of atherosclerotic cardiovascular disease. Arch Med Res 2015;46:328-38.
29. Chen M, Zhang H, Liu W, Zhang W. The global pattern of urbanization and economic growth: evidence from the last three decades. PloS one 2014;9:e103799.
30. Turok I, McGranahan G. Urbanization and economic growth: the arguments and evidence for Africa and Asia. Environment and Urbanization 2013;25:465-82.
31. Preacher KJ, Hayes AF. Assessing mediation in communication research. The Sage sourcebook of advanced data analysis methods for communication research 2008:13-54.
32. Lewington S, Lacey B, Clarke R, Guo Y, Kong XL, Yang L, et al. The burden of hypertension and associated risk for cardiovascular mortality in China. JAMA internal medicine 2016;176:524-32.
33. Sahakyan KR, Somers VK, Rodriguez-Escudero JP, Hodge DO, Carter RE, Sochor O, et al. Normal-weight central obesity: implications for total and cardiovascular mortality. Ann Intern Med 2015;163:827-35.
34. Lavie CJ, De Schutter A, Parto P, Jahangir E, Kokkinos P, Ortega FB, et al. Obesity and prevalence of cardiovascular diseases and prognosis—the obesity paradox updated. Prog Cardiovasc Dis 2016;58:537-47.
35. Sajid MR, Muhammad N, Zakaria R, Shahbaz A, Nauman A. Associated Factors of Cardiovascular Diseases in Pakistan: Assessment of Path Analyses Using Warp Partial Least Squares Estimation. Pakistan Journal of Statistics and Operation Research 2020:265-77.
36. Smyth A, Teo KK, Rangarajan S, O'Donnell M, Zhang X, Rana P, et al. Alcohol consumption and cardiovascular disease, cancer, injury, admission to hospital, and mortality: a prospective cohort study. The Lancet 2015;386:1945-54.
37. Malik VS, Willett WC, Hu FB. Global obesity: trends, risk factors and policy implications. Nature Reviews Endocrinology 2013;9:13.
38. Assessment E. Urbanization and health. B World Health Organ 2010;88:245-46.
39. Khatib R, McKee M, Shannon H, Chow C, Rangarajan S, Teo K, et al. Availability and affordability of cardiovascular disease medicines and their effect on use in high-income, middle-income, and low-income countries: an analysis of the PURE study data. Lancet 2016;387:61-69.
40. Singh AR, Singh SA. Diseases of poverty and lifestyle, well-being and human development. Mens sana monographs 2008;6:187.
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