Sex and Gender Influence on Cardiovascular Health in Sub-Saharan Africa: Findings from Ghana, Gambia, Mali, Guinea, and Botswana
Rubee Dev, Divine‐Favour Chichenim Ofili, Valeria Raparelli, Hassan Behlouli, Zahra Azizi, Karolina Kublickiene, Alexandra Kautzky‐Willer, María Trinidad Herrero, Louise Pilote, Colleen M. Norris
Abstract
<strong>Background:</strong> 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. <strong>Objective:</strong> To examine the associations between biological sex, gender-related variables, and cardiovascular health (CVH) risk factors in SSA countries. <strong>Methods:</strong> We used data from the STEPwise approach to surveillance of risk factors for non-communicable disease survey, conducted in adults from Ghana, Gambia, Mali, Guinea, and Botswana. The main outcome was CVH, measured through the health index with values ranging from 0 (worst) to 5 (best or ideal) CVH. Multivariable logistic regression was applied to determine the gender-related factors related to poorer CVH (index less than 4). <strong>Results:</strong> 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<sub>female</sub> = 0.95, 95% CI:0.91–0.99). Being married was associated with better CVH compared with being single, more so for males (OR<sub>male</sub> = 1.09, 95% CI:0.96–1.24, p<sub>interaction</sub> < 0.01). Males with unpaid work (OR<sub>male</sub> = 1.28, 95% CI:1.12–1.47) had better CVH than their unpaid female counterparts (OR<sub>female</sub> = 1.08, 95% CI:1.01–1.17). <strong>Conclusion:</strong> In SSA populations, 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.