Sex and gender influence on cardiovascular health in sub-saharan Africa: findings from Ghana, Gambia, Mali, Guinea, and Botswana

Abstract Background Sex and gender-based differences in cardiovascular health (CVH) has been explored in the context of high-income countries. However, these relationships have not been examined in low- and middle-income countries. There is an upsurge of cardiovascular diseases (CVDs) in sub-Saharan Africa (SSA). Irrespective of biological sex, gender-related factors could be the precursor of these conditions. Purpose To examine the associations between biological sex, gender-related variables, and CVH risk factors in SSA countries. Methods We conducted a retrospective analysis of the World Health Organization's “STEPwise approach to surveillance of risk factors for non-communicable disease” or “STEPS” survey, conducted in adults aged 18–69 years from Ghana, Gambia, Mali, Guinea, and Botswana. The surveys were conducted between 2006 and 2014. The main outcome was CVH, as measured by a composite measure of STEPS-HEART health index (smoking, hypertension, diabetes, obesity/overweight, and daily consumption of fruits and vegetables), values ranging from 0 (worst) to 5 (best or ideal). Multivariable logistic regression was applied to determine the gender-related factors related to poorer CVH (index less than 4). Two-way interaction between the sex and gender-related factors were tested by including an interaction term in bivariate models. Results Data included 15,356 adults (61.4% females, mean age 36.9 years). The prevalence of hypertension (21.6% vs. 13.8%) and overweight/obesity (48.3% vs. 27.5%) was higher among females as compared to males. Females were more likely to be unemployed (17.3% vs. 9.7%) or reported unpaid work (36.8% vs. 15.2%). Overall, females showed worse CVH than males (OR female = 0.95, 95% CI: 0.91–0.99). Being married was associated with better CVH compared with being single, more so for males (OR male = 1.09, 95% CI: 0.96–1.24, p interaction <0.01). Males with unpaid work (OR male = 1.28, 95% CI: 1.12–1.47) had better CVH than their unpaid female counterparts (OR female = 1.08, 95% CI: 1.01–1.17). Conclusion This study highlights an alarmingly high prevalence of CVD risk factors, mainly overweight/obesity and hypertension among females in SSA population. Being female was associated with poorer CVH given the disproportionate burden of hypertension and overweight/obesity. Gender-related factors such as marital status and unpaid work were associated with better CVH in males compared to females. With the rising prevalence of CVDs in SSA, it will be important to consider the gender-related factors while implementing preventive programs and creating effective health policies. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): The GENDER– NET Plus ERA-NET Initiative (project ref. number: GNP-78): The Canadian Institutes of Health Research (GNP-161904)