Urbanization and cardiovascular health among Indigenous groups in Brazil

Abstract

Background: We described the prevalence of cardiovascular risk factors in groups of Brazilian Indigenous people at different degrees of urbanization.

Methods: The Project of Atherosclerosis among Indigenous populations (Projeto de Aterosclerose em Indígenas; PAI) is a cross-sectional study conducted in Northeast Brazil between August 2016-June 2017. It included three populations: Fulni-ô Indigenous people (lowest degree of urbanization), Truká Indigenous people (greater urbanization), and a highly urbanized non-Indigenous local cohort (control group). Participants were assessed to register sociodemographic, anthropometric, as well as clinical and laboratory-derived cardiovascular (CV) risk parameters. Age-adjusted prevalence of hypertension was also computed. Nonparametric tests were used for group comparisons.

Results: Here we included 999 participants, with a predominance of females in all three groups (68.3% Control group, 65.0% Fulni-ô indigenous group, and 60.1% Truká indigenous group). Obesity was present in 45.6% of the urban non-Indigenous population, 37.7% Truká and in 27.6% Fulni-ô participants. The prevalence of hypertension was 29.1% (n = 297) with lower prevalence in the less urbanized Fulni-ô people (Fulni-ô - 18.2%; Truká - 33.9%; and Control - 33.8%; p < 0.001). In the elderly male population, the prevalence of hypertension was 18.7% in the Fulni-ô, 45.8% in the Truká, and 54.5% in the control group. Of the 342 participants that self-reported hypertension, 37.5% (n = 68) showed uncontrolled blood pressure (BP). Uncontrolled BP was more prevalent among Truká people when compared to Fulni-ô people and non-Indigenous participants (45.4%, 22.9%, and 40.7%, respectively; p < 0.001).

Conclusions: We found a higher cardiovascular risk in communities with a higher degree of urbanization, suggesting that living in towns and cities may have a negative impact on these aspects of cardiovascular health.

Fig. 1. Study population and territorial area, for Fulni-ô Indigenous people, Truká Indigenous people, and urban non-Indigenous population in Juazeiro.

Made with Natural Earth. Map base layers were modified in QGIS software version 2.18. Pictures from the PAI researchers (no Indigenous person shown).

Fig. 2. Prevalence of hypertension and obesity diseases for Fulni-ô Indigenous people, Truká Indigenous people, and urban non-Indigenous population.

Brazil. a Hypertension; b Uncontrolled blood pressure; c obesity. Total population (n = 999): the least urbanized Fulni-ô People (n = 303; 30.3%); the intermediate urbanized Truká Indigenous group (n = 336; 33.7%); as well as a highly urbanized cohort living in the city of Juazeiro (n = 360; 36.0%). *Control group refers to the urban non-Indigenous population.