Modifiable risk factors and overall cardiovascular mortality: Moderation of urbanization

  • Mirza Rizwan Sajid Centre for Mathematical Sciences, College of Computing and Applied Sciences, Universiti Malaysia Pahang, Gambang, Malaysia.
  • Noryanti Muhammad | Centre for Mathematical Sciences, College of Computing and Applied Sciences, Universiti Malaysia Pahang, Lebuhraya Tun Razak, 26300 Gambang, Kuantan, Pahang Darul Makmur, Malaysia, Malaysia.
  • Roslinazairimah Zakaria Centre for Mathematical Sciences, College of Computing and Applied Sciences, Universiti Malaysia Pahang, Lebuhraya Tun Razak, 26300 Gambang, Kuantan, Pahang Darul Makmur, Malaysia, Malaysia.
  • Syed Ahmad Chan Bukhari Centre for Mathematical Sciences, College of Computing and Applied Sciences, Universiti Malaysia Pahang, Gambang, Malaysia.


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.



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Original Articles
Supporting Agencies
We gratefully thank Universiti Malaysia Pahang for financial support under Post Graduate Research Scheme (PGRS190350) to conduct the study.
Modifiable risk factors, cardiovascular mortality, urbanization, forms of urbanization, moderation
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How to Cite
Sajid, M. R., Muhammad, N., Zakaria, R., & Bukhari, S. A. C. (2020). Modifiable risk factors and overall cardiovascular mortality: Moderation of urbanization. Journal of Public Health Research, 9(4).