Sex and Gender Influence on Cardiovascular Health in Sub-Saharan Africa: Findings from Ghana, Gambia, Mali, Guinea, and Botswana

Rubee Dev; Divine-Favour Ofili; Valeria Raparelli; Hassan Behlouli; Zahra Azizi; Karolina Kublickiene; Alexandra Kautzky-Willer; Maria Trinidad Herrero; Louise Pilote; Colleen M. Norris; on behalf of the GOING-FWD Consortium

doi:10.5334/gh.1146

Sex and Gender Influence on Cardiovascular Health in Sub-Saharan Africa: Findings from Ghana, Gambia, Mali, Guinea, and Botswana

Volume 17 (2022): Issue 1

By: Rubee Dev , Divine-Favour Ofili , Valeria Raparelli , Hassan Behlouli , Zahra Azizi , Karolina Kublickiene , Alexandra Kautzky-Willer , Maria Trinidad Herrero , Louise Pilote , Colleen M. Norris and on behalf of the GOING-FWD Consortium

Open Access

|Sep 2022

Figures & Tables

Table 1

Descriptive characteristics of survey respondents, by biological sex (n = 15356).

	N¹	OVERALL	BIOLOGICAL SEX
		OVERALL	FEMALE (N = 9425)	MALE (N = 5931)
		N (%) OR MEAN [SD]	N (%) OR MEAN [SD]	N (%) OR MEAN [SD]
Demographic variables
Country/Survey year	15356
Ghana, 2006		2662 (17.3)	1773 (18.8)	889 (15.0)
Gambia, 2010		4103 (26.7)	2335 (24.8)	1768 (29.8)
Mali, 2007		2401 (15.6)	1441 (15.3)	960 (16.2)
Guinea, 2009		2288 (14.9)	1230 (13.1)	1058 (17.8)
Botswana, 2014		3902 (25.4)	2646 (28.1)	1256 (21.2)
Age (in years)	15356	37.5 [12.5]	36.9 [12.3]	38.5 [12.8]
Age categories	15356
<20		917 (6.0)	568 (6.0)	349 (5.9)
20–29		4789 (31.2)	3138 (33.3)	1651 (27.8)
30–39		4121 (26.8)	2559 (27.2)	1562 (26.3)
40–49		2770 (18.0)	1069 (17.1)	1161 (19.6)
50–59		1962 (12.8)	1101 (11.7)	861 (14.5)
60–69		797 (5.2)	459 (4.8)	347 (5.9)
Gender variables
Education level	15295
Less than secondary		8350 (54.6)	5548 (59.1)	2802 (47.4)
Secondary		5514 (36.1)	3195 (34.0)	2319 (39.3)
Post-secondary		1431 (9.4)	645 (6.9)	786 (13.3)
Marital status	15278
Single/Never married		4575 (29.9)	2486 (26.5)	2089 (35.4)
Married/Common in law		9484 (62.1)	5888 (62.8)	3596 (61.0)
Widow/Separated/Divorced		1219 (8.0)	1006 (10.7)	213 (3.6)
Work status	14559
Paid		8363 (57.4)	4051 (45.9)	4312 (75.2)
Unpaid		4114 (28.3)	3244 (36.8)	870 (15.2)
Unemployed		2082 (14.3)	1527 (17.3)	555 (9.7)
Household size	14955
1 person		2530 (16.9)	1512 (16.5)	1018 (17.6)
2 persons		4224 (28.2)	2667 (29.1)	1557 (26.8)
3 persons		2733 (18.3)	1776 (19.4)	957 (16.5)
4 persons		1623 (10.9)	963 (10.5)	660 (11.4)
≥5 persons		3845 (25.7)	2238 (24.4)	1607 (27.7)
Annual household income (USD)	11819
<20000		9106 (77.0)	5312 (75.5)	3794 (79.4)
≥20000		2713 (23.0)	56 (24.5)	67 (20.6)
Cardiovascular risk-factors
Smoking	15179
Smoker		1859 (12.2)	210 (2.2)	1649 (28.4)
Non-smoker		13320 (87.8)	9169 (97.8)	4151 (71.6)
Overweight/obesity	14673
BMI < 25		8767 (59.7)	4642 (51.7)	4125 (72.5)
BMI ≥ 25		5906 (40.3)	4343 (48.3)	1563 (27.5)
Leisure physical activity	1576
<30 mins activity		226 (14.3)	138 (20.0)	88 (9.9)
≥30 mins activity		1350 (85.7)	552 (80.0)	798 (90.1)
Fruit and vegetable consumption	10700
<5 servings/day		7205 (67.3)	4490 (68.1)	2715 (66.2)
≥5 servings/day		3495 (32.7)	2107 (31.9)	1388 (33.8)
Hypertension	11907
Yes		2247 (18.9)	1671 (21.6)	576 (13.8)
No		9660 (81.1)	6057 (78.4)	3603 (86.2)
Diabetes	6807
Yes		311 (4.6)	215 (4.9)	96 (4.0)
No		6496 (95.4)	4162 (95.1)	2334 (96.0)
Outcome variable
STEPS-HEART Index (Africa)	4271
0		4 (0.1)	2 (0.1)	2 (0.1)
1		80 (1.9)	26 (1.8)	54 (1.9)
2		415 (9.7)	109 (7.4)	306 (10.9)
3		1464 (34.3)	441 (29.9)	1023 (36.6)
4		1696 (39.7)	605 (41.0)	1091 (39.0)
5		612 (14.3)	291 (19.7)	321 (11.5)

[i] Note: BMI (Body Mass Index); SD (Standard Deviation).

¹ Number of complete observations (excludes missing data).

STEPS-HEART index value of ≥4 indicates better CVH and value <4 indicates poor CVH.

Cardiovascular risk-factors of the respondents by biological sex.

Table 2

Multiple imputation logistic regression model for assessing association of gender-related variables with cardiovascular health, overall and by biological sex.

CARDIOVASCULAR HEALTH (STEPS-HEART INDEX)	OVERALL		FEMALE		MALE		P INTERACTION
CARDIOVASCULAR HEALTH (STEPS-HEART INDEX)	OR (95% CI)	P-VALUE	OR (95% CI)	P-VALUE	OR (95% CI)	P-VALUE	P INTERACTION
Sex (Female)	0.95 (0.91–0.99)	0.01
Age
<20	2.06 (0.50–8.48)	0.32	2.35 (0.56–9.81)	0.25	1.54 (0.36–6.55)	0.56	0.15
20–29 (ref)	–	–	–	–	–	–	–
30–39	1.14 (0.85–1.51)	0.39	1.25 (0.93–1.68)	0.16	1.07 (0.79–1.44)	0.68	<0.05
40–49	0.76 (0.56–1.02)	0.07	0.77 (0.57–1.04)	0.09	0.79 (0.57–1.08)	0.14	0.60
50–59	0.65 (0.49–0.87)	0.01	0.58 (0.43–0.78)	<0.001	0.80 (0.58–1.11)	0.18	<0.01
60–69	0.48 (0.35–0.66)	<0.001	0.37 (0.26–0.53)	<0.001	0.67 (0.47–0.97)	<0.05	<0.001
Education level
Less than secondary (ref)	–		–		–
Secondary	0.99 (0.94–1.05)	0.81	0.93 (0.86–1.02)	0.11	1.10 (1.01–1.20)	<0.05	<0.01
Post-secondary	0.91 (0.84–0.99)	<0.05	0.87 (0.77–0.98)	<0.05	0.92 (0.83–1.03)	0.16	0.54
Marital status
Single/Never married (ref)	–		–		–
Married/Common in law	1.11 (1.04–1.18)	<0.01	1.05 (0.98–1.14)	0.16	1.09 (0.96–1.24)	0.19	<0.01
Widow/Separated/Divorced	0.99 (0.89–1.09)	0.79	1.03 (0.93–1.15)	0.57	0.93 (0.75–1.16)	0.54	0.59
Work status
Paid (ref)	–		–		–
Unpaid	1.14 (1.08–1.21)	<0.001	1.08 (1.01–1.17)	<0.05	1.28 (1.12–1.47)	<0.001	0.23
Unemployed	0.84 (0.79–0.90)	<0.001	0.87 (0.79–0.95)	<0.01	0.78 (0.68–0.89)	<0.001	0.60
Household size
1 (ref)	–		–		–
2	0.93 (0.86–0.99)	<0.05	0.88 (0.81–0.96)	<0.01	0.99 (0.89–1.11)	0.97	0.79
3	0.96 (0.88–1.05)	0.36	0.96 (0.87–1.07)	0.47	0.95 (0.84–1.09)	0.49	0.29
4	0.99 (0.90–1.09)	0.92	0.99 (0.88–1.13)	0.98	0.98 (0.84–1.15)	0.83	0.93
≥5	1.30 (1.19–1.43)	<0.001	1.39 (1.24–1.56)	<0.001	1.18 (1.05–1.34)	<0.01	<0.05

[i] Note: OR (Odds Ratio); CI (Confidence Interval); STEPS-HEART index (4 or 5: Better CVH vs. <4: Poorer CVH).

Table 3

Multiple imputation logistic regression model for assessing association of gender-related variables with cardiovascular health, by country.

CARDIOVASCULAR HEALTH (STEPS-HEART INDEX)	GHANA		GAMBIA		MALI		GUINEA		BOTSWANA
CARDIOVASCULAR HEALTH (STEPS-HEART INDEX)	OR (95% CI)	P-VALUE	OR (95% CI)	P-VALUE	OR (95% CI)	P-VALUE	OR (95% CI)	P-VALUE	OR (95% CI)	P-VALUE
Sex (Female)	0.73 (0.66–0.80)	<0.001	1.07 (0.97–1.19)	0.15	0.98 (0.88–1.09)	0.67	0.99 (0.89–1.11)	0.94	1.00 (0.93–1.09)	0.93
Age
<20	NA		NA		2.76 (1.87–4.06)	<0.001	1.57 (0.17–14.18)	0.69	1.34 (0.15–11.52)	0.79
20–29 (ref)	–	–	–	–	–	–	–	–	–	–
30–39	1.28 (1.09–1.49)	<0.01	1.38 (1.19–1.59)	<0.001	1.04 (0.82–1.32)	0.76	1.18 (0.72–1.95)	0.51	1.14 (0.72–1.81)	0.57
40–49	0.90 (0.76–1.06)	0.21	0.88 (0.74–1.03)	0.11	0.61 (0.48–0.77)	<0.001	0.83 (0.51–1.36)	0.47	0.97 (0.61–1.55)	0.91
50–59	0.87 (0.72–1.04)	0.12	0.77 (0.63–0.93)	<0.01	0.72 (0.55–0.94)	<0.05	0.68 (0.41–1.13)	0.14	0.59 (0.37–0.95)	<0.05
60–69	0.56 (0.41–0.75)	<0.001	0.59 (0.42–0.82)	<0.01	0.50 (0.34–0.73)	<0.001	0.51 (0.28–0.91)	<0.05	0.57 (0.34–0.98)	<0.05
Education level
Less than secondary (ref)	–		–		–		–		–
Secondary	0.89 (0.79–1.01)	0.07	1.16 (0.99–1.37)	0.06	0.96 (0.69–1.35)	0.82	0.89 (0.73–1.08)	0.24	0.99 (0.89–1.11)	0.90
Post-secondary	1.07 (0.89–1.29)	0.46	0.67 (0.53–0.83)	<0.001	0.84 (0.45–1.57)	0.59	1.08 (0.84–1.39)	0.54	1.03 (0.90–1.17)	0.66
Marital status
Single/Never married (ref)	–		–		–		–		–
Married/Common in law	0.99 (0.89–1.13)	0.93	1.12 (0.97–1.28)	0.11	1.19 (0.99–1.43)	0.06	0.99 (0.84–1.19)	0.98	0.95 (0.82–1.11)	0.53
Widow/Separate/Divorce	0.95 (0.79–1.13)	0.56	0.89 (0.70–1.12)	0.32	0.88 (0.63–1.22)	0.42	0.75 (0.56–1.01)	0.06	0.91 (0.72–1.15)	0.44
Work status
Paid (ref)	–		–		–		–		–
Unpaid	1.03 (0.79–1.34)	0.85	1.19 (1.02–1.39)	<0.05	1.19 (0.97–1.48)	0.09	0.91 (0.72–1.15)	0.44	1.14 (1.01–1.29)	<0.05
Unemployed	0.98 (0.77–1.23)	0.84	0.80 (0.63–1.03)	0.07	0.87 (0.71–1.07)	0.19	1.11 (0.76–1.61)	0.58	0.99 (0.89–1.11)	0.92
Household size
1 (ref)	–		–		–		–		–
2	0.93 (0.81–1.08)	0.35	1.03 (0.90–1.17)	0.66	0.97 (0.72–1.31)	0.86	0.99 (0.81–1.21)	0.94	0.95 (0.82–1.09)	0.44
3	0.93 (0.78–1.09)	0.36	1.02 (0.89–1.16)	0.80	0.92 (0.66–1.29)	0.64	1.02 (0.82–1.27)	0.85	1.02 (0.86–1.21)	0.81
4	0.99 (0.81–1.23)	0.97	1.03 (0.86–1.22)	0.77	0.99 (0.69–1.43)	0.99	0.98 (0.76–1.28)	0.93	0.95 (0.76–1.18)	0.62
≥5	1.02 (0.84–1.24)	0.84	1.25 (1.09–1.42)	<0.01	1.16 (0.95–1.42)	0.15	1.17 (0.96–1.44)	0.12	1.17 (0.94–1.47)	0.14

[i] Note: NA (Not available); OR (Odds Ratio); CI (Confidence Interval); STEPS-HEART index (4 or 5: Better CVH vs. <4: Poorer CVH).

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DOI: https://doi.org/10.5334/gh.1146 | Journal eISSN: 2211-8179

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Language: English

Submitted on: Mar 15, 2022

Accepted on: Jul 26, 2022

Published on: Sep 1, 2022

Published by: Ubiquity Press

In partnership with: Paradigm Publishing Services

Publication frequency: 1 issue per year

Keywords:

Cardiovascular health,

Cardiovascular diseases,

sub-Saharan Africa,

Sex,

Gender

© 2022 Rubee Dev, Divine-Favour Ofili, Valeria Raparelli, Hassan Behlouli, Zahra Azizi, Karolina Kublickiene, Alexandra Kautzky-Willer, Maria Trinidad Herrero, Louise Pilote, Colleen M. Norris, on behalf of the GOING-FWD Consortium, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 17 (2022): Issue 1

Sex and Gender Influence on Cardiovascular Health in Sub-Saharan Africa: Findings from Ghana, Gambia, Mali, Guinea, and Botswana

Figures & Tables

Table 1

Figure 1

Table 2

Table 3

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