Socioeconomic determinants of cardiovascular risk in underserved communities

Abstract

Approximately 27% of Kenya’s 50 million people live in urban areas. The majority (56%) live in slums or slum-like settings, with limited access to functional [public] health care in a setting where poverty and insecurity are rampant. In 2015/16, one in every three Kenyan lived below the international poverty line (US$1.90 per day in 2011 per person). The poor, who are disproportionately affected by cardiovascular diseases (CVD), lack livelihood opportunities due to unemployment and are likely to possess low levels of education or be ignorant about CVD risk factors. The goal of this study was to determine the link between socioeconomic factors and risk and mortality from CVD, with the aim of informing interventions for prevention and control of CVD in underserved populations in Kenya. Based on data from the 2015 STEPWise survey on non-communicable diseases risk factors (STEPs), we determined that three in four Kenyan adults possessed between four and six non-communicable diseases (NCD) risk factors from among insufficient physical activity, smoking/tobacco use, harmful alcohol consumption, overweight and obesity, hypertension, and diabetes, indicating an emerging NCD epidemic in the country. Age, sex, level of education and socioeconomic status were key determinants. In slums of Nairobi, the understanding of and perceptions towards NCD and CVD were influenced by literacy levels, while ignorance towards risk factors, stigma and poverty, and perceived high cost of health care negatively affected care-seeking and treatment-adherence for CVD. Mortality from CVD was inversely correlated with gainful unemployment and higher levels of education. Investing in educating the public on CVD and risk factors, while empowering their access to livelihood opportunities are socioeconomic interventions that can enhance primordial prevention and treatment-adherence for CVD in Kenya.