Disparities in the non-laboratory INTERHEART risk score and its components in selected countries of Europe and sub-Saharan Africa: Analysis from the SPICES multi-country project

Hamid Y Hassen, Steven Abrams, G. Musinguzi, Imogen Rogers, Alfred Dusabimana, P. Mphekgwana, H. Bastiaens, H. Bastiaens, Hamid Y Hassen, N. Aerts, S. Anthierens, Kathleen Van Royen, Caroline Masquillier, Jean Yves Le Reste, D. Le Goff, G. Perraud, Harm van Marwijk, Elisabeth Ford, Tom Grice-Jackson, Imogen Rogers, P. Nahar, Linda Gibson, M. Bowyer, Almighty Nkengateh, G. Musinguzi, R. Ndejjo, Fred Nuwaha, T. Sodi, P. Mphekgwana, Nancy Malema, Nancy Kgatla, T. Mothiba
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Abstract

Accurate prediction of a person’s risk of cardiovascular disease (CVD) is vital to initiate appropriate intervention. The non-laboratory INTERHEART risk score (NL-IHRS) is among the tools to estimate future risk of CVD. However, measurement disparities of the tool across contexts are not well documented. Thus, we investigated variation in NL-IHRS and components in selected sub-Saharan African and European countries. We used data from a multi-country study involving 9309 participants, i.e., 4941 in Europe, 3371 in South Africa and 997 in Uganda. Disparities in total NL-IHRS score, specific subcomponents, subcategories, and their contribution to the total score was investigated. The variation in the adjusted total and component scores were compared across contexts using analysis of variance. The adjusted mean NL-IHRS was higher in South Africa (10.2) and Europe (10.0) compared to Uganda (8.2) and the difference was statistically significant (p<0.001). The prevalence and percent contribution of diabetes mellitus and high blood pressure were lowest in Uganda. Score contribution of non-modifiable factors was lower in Uganda and South Africa, entailing 11.5% and 8.0% of the total score respectively. Contribution of behavioral factors to the total score was highest in both sub-Saharan African countries. In particular, adjusted scores related to unhealthy dietary patterns were highest in South Africa (3.21) compared to Uganda (1.66) and Europe (1.09). Whereas contribution of metabolic factors was highest in Europe (30.6%) compared with Uganda (20.8%) and South Africa (22.6%). The total risk score, subcomponents, categories, and their contribution to total score greatly varies across contexts, which could be due to disparities in risk burden and/or self-reporting bias in resource limited settings. Therefore, primary preventive initiatives should identify risk factor burden across contexts and intervention activities need to be customized accordingly. Furthermore, contextualizing the risk assessment tool and evaluating its usefulness in different settings is recommended.
欧洲和撒哈拉以南非洲部分国家非实验室 INTERHEART 风险评分及其组成部分的差异:SPICES 多国项目分析
准确预测一个人患心血管疾病(CVD)的风险对于启动适当的干预至关重要。非实验室INTERHEART风险评分(NL-IHRS)是评估未来心血管疾病风险的工具之一。然而,该工具在不同环境中的度量差异并没有很好的文档化。因此,我们在选定的撒哈拉以南非洲和欧洲国家调查了NL-IHRS及其组成部分的变化。我们使用了一项涉及9309名参与者的多国研究的数据,即欧洲4941人,南非3371人,乌干达997人。研究了NL-IHRS总分、特定子成分、子类别及其对总分的贡献的差异。使用方差分析比较不同背景下调整后的总得分和成分得分的差异。调整后的平均NL-IHRS在南非(10.2)和欧洲(10.0)高于乌干达(8.2),差异有统计学意义(p<0.001)。糖尿病和高血压的患病率和百分比在乌干达最低。乌干达和南非的不可修改因素得分贡献度较低,分别占总分的11.5%和8.0%。在这两个撒哈拉以南非洲国家,行为因素对总分的贡献最高。特别是,与不健康饮食模式相关的调整得分在南非最高(3.21),而乌干达(1.66)和欧洲(1.09)。而代谢因素的贡献在欧洲最高(30.6%),乌干达(20.8%)和南非(22.6%)。总风险评分、子成分、类别及其对总分的贡献在不同环境下差异很大,这可能是由于风险负担的差异和/或资源有限环境下的自我报告偏差。因此,初级预防行动应确定各种情况下的风险因素负担,并需要相应地定制干预活动。此外,建议将风险评估工具置于环境中并评估其在不同环境中的有用性。
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