Abstract
BackgroundVariations in the distribution of cardiovascular disease and risk factors by socioeconomic status (SES) have been described in affluent societies, yet a better understanding of these patterns is needed for most low- and middle-income countries.ObjectiveThis study sought to describe the relationship between cardiovascular risk factors and SES using monthly family income, educational attainment, and assets index, in 4 Peruvian sites.MethodsBaseline data from an age- and sex-stratified random sample of participants, ages ≥35 years, from 4 Peruvian sites (CRONICAS Cohort Study, 2010) were used. The SES indicators considered were monthly family income (n = 3,220), educational attainment (n = 3,598), and assets index (n = 3,601). Behavioral risk factors included current tobacco use, alcohol drinking, physical activity, daily intake of fruits and vegetables, and no control of salt intake. Cardiometabolic risk factors included obesity, elevated waist circumference, hypertension, insulin resistance, diabetes mellitus, low high-density lipoprotein cholesterol, and high triglyceride levels.ResultsIn the overall population, 41.6% reported a monthly family income <US$198, and 45.6% had none or primary education. Important differences were noted between the socioeconomic indicators: for example, higher income and higher scores on an asset index were associated with greater risk of obesity, whereas higher levels of education were associated with lower risk of obesity. In contrast, higher SES according to all 3 indicators was associated with higher levels of triglycerides.ConclusionsThe association between SES and cardiometabolic risk factors varies depending on the SES indicator used. These results highlight the need to contextualize risk factors by socioeconomic groups in Latin American settings.
Highlights
Variations in the distribution of cardiovascular disease and risk factors by socioeconomic status (SES) have been described in affluent societies, yet a better understanding of these patterns is needed for most low- and middle-income countries
A better understanding of these patterns is needed for most low- and middle-income countries (LMIC) as the prevalence of risk factors for cardiovascular disease, such as obesity, hypertension, or diabetes mellitus, is increasing in Latin America [5e8]
In high-income countries, there is a negative association between obesity and higher income and educational attainment, whereas in low-income countries, there is a positive association between education and obesity [17,21]
Summary
Baseline data from an age- and sex-stratified random sample of participants, ages !35 years, from 4 Peruvian sites (CRONICAS Cohort Study, 2010) were used. Cardiometabolic risk factors included obesity, elevated waist circumference, hypertension, insulin resistance, diabetes mellitus, low high-density lipoprotein cholesterol, and high triglyceride levels. We used baseline data from the CRONICAS Cohort Study, conducted by CRONICAS Center of Excellence in Chronic Diseases [37], which was originally designed to investigate the prevalence of cardiovascular and chronic pulmonary diseases and its progression in 4 different rural/urban and coastal/high-altitude Peruvian settings [38]. We identified a sex-and-age stratified random sample (35 to 44, 45 to 54, 55 to 64, and !65 years) of eligible subjects and enrolled only 1 participant per household. Baseline data from 2010 was used for this study and analyzed in 2015
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