CARDIOVASCULAR RISK FACTORS IN SOCIAL HOUSING RESIDENTS: A MULTI-SITE DESCRIPTIVE SURVEY IN OLDER ADULTS FROM ONTARIO, CANADA

Abstract

Older adults living in subsidized housing are a vulnerable population with higher rates of poverty and increased risk of cardiovascular events. Larger population surveys may not adequately capture data from this population due to poor literacy and low participation rates. The purpose of this study was to determine the prevalence of cardiovascular disease risk factors in older adults residing in social housing. This was a cross-sectional study with interviewer-administered questionnaire and objective blood pressure (BP) measurement with a validated, automated device. Data was collected from residents aged 55 years and older residing in 25 subsidized social housing apartment buildings in five Ontario regions. Outcome measures were prevalence of cardiovascular risk factors in this population and association of the risk factors with measured high BP, controlled hypertension, and undiagnosed hypertension. In 1101 residents, mean age was 72.4 years, 78% were female, 87% white, and 69% had high school education or less. Self-reported risk factors included diabetes (29%), hypertension (59%), high cholesterol (44%), overweight (30%) or obese (39%), current smoker (29%), < 1 serving of fruit/vegetable daily (61%), and physical activity < 30 minutes daily (50%). Conditions that could indirectly impact cardiovascular health were limited mobility (58%), difficulty performing usual activities (41%), and pain/discomfort (70%). In a subset of 595 residents with BP measured, 304 (51%) had high BP. Any post-secondary education (OR=0.53, 95%CI 0.32-0.90), non-white ethnicity (OR=0.49, 95%CI 0.27-0.89), 75-84 years (OR=2.13, 95%CI 1.23-3.69), 85+ years (OR=2.77, 95%CI 1.26-6.12), and 1-4 medications (OR=1.90, 95%CI 1.06-3.42) were significantly associated with high BP. Non-white ethnicity (OR=0.36, 95%CI 0.17-0.78) was associated with uncontrolled hypertension. Physical activity (OR=0.41, 95%CI 0.20-0.85), 75-84 years (3.65, 95%CI 1.34-9.95), and 85+ years (OR=9.33, 95%CI 1.65-52.62) were associated with undiagnosed hypertension. There is a high prevalence of modifiable cardiovascular risk factors in this vulnerable population and the majority had either undiagnosed or unmanaged high BP. Although dietary risk factors were prevalent, they were not significantly associated with high BP, suggesting that other low-income factors may have a greater influence. Cardiometabolic sequelae are likely unless primary care interventions appropriate for this population are implemented.