Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comment
. 2024 Aug 1;9(8):692-701.
doi: 10.1001/jamacardio.2024.1286.

Neighborhood Social Vulnerability and Premature Cardiovascular Disease in Haiti

Nicholas L S Roberts  1   2 , Rodney Sufra  3 , Lily D Yan  1   2 , Reichling St Sauveur  3 , Joseph Inddy  3 , Youry Macius  3 , Michel Théard  4 , Myung Hee Lee  1 , Nour Mourra  1 , Rehana Rasul  5   6 , Denis Nash  5   6 , Marie M Deschamps  3 , Monika M Safford  2 , Jean W Pape  3 , Vanessa Rouzier  3 , Margaret L McNairy  1   2
Affiliations
Comment

Neighborhood Social Vulnerability and Premature Cardiovascular Disease in Haiti

Nicholas L S Roberts et al. JAMA Cardiol. .

Abstract

Importance: Higher social vulnerability is associated with premature cardiovascular disease (CVD) and mortality but is understudied in low-income countries that have both the highest magnitude of social vulnerability and a growing CVD epidemic.

Objective: To evaluate the association between social vulnerability and hypertension, CVD, and CVD subtypes in Haiti as a model for similar low-income countries.

Design, setting, and participants: This population-based cohort study used enrollment data from adults participating in the Haiti Cardiovascular Disease Cohort Study. Recruitment occurred via multistage random sampling throughout slum and urban neighborhoods in Port-au-Prince, Haiti, from March 2019 to August 2021. Data were analyzed from May 2022 to December 2023.

Exposures: A modified Haitian Social Vulnerability Index (SVI-H) was created following the US Centers for Disease Control and Prevention Social Vulnerability Index method. Twelve variables across the domains of socioeconomic status, household characteristics, and social and community context were included. The SVI-H was calculated for each study neighborhood block and then stratified into SVI-H quartiles (quartile 1 was the least vulnerable; quartile 4, the most vulnerable).

Main outcomes and measures: Prevalent hypertension and total CVD, defined as heart failure (HF), stroke, transient ischemic attack (TIA), angina, or myocardial infarction (MI). Age-adjusted Poisson regression analysis yielded prevalence ratios (PRs) comparing the prevalence of hypertension, total CVD, and CVD subtypes across SVI-H quartiles.

Results: Among 2925 adults (1704 [58.3%] female; mean [SD] age, 41.9 [15.9] years), the prevalence of hypertension was 32.8% (95% CI, 31.1%-34.5%) and the prevalence of CVD was 14.7% (95% CI, 13.5%-16.0%). Hypertension prevalence ranged from 26.2% (95% CI, 23.1%-29.3%) to 38.4% (95% CI, 34.8%-42.0%) between quartiles 1 and 4, while CVD prevalence ranged from 11.1% (95% CI, 8.8%-13.3%) to 19.7% (95% CI, 16.8%-22.6%). SVI-H quartile 4 vs 1 was associated with a greater prevalence of hypertension (PR, 1.17; 95% CI, 1.02-1.34) and CVD (PR, 1.48; 95% CI, 1.16-1.89). Among CVD subtypes, SVI-H was significantly associated with HF (PR, 1.64; 95% CI, 1.23-2.18) but not with combined stroke and TIA or combined angina and MI.

Conclusions and relevance: In urban Haiti, individuals living in neighborhoods with the highest social vulnerability had greater prevalence of hypertension and HF. Understanding CVD disparities in low-income countries is essential for targeting prevention and treatment interventions toward populations at highest risk globally.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Lee reported grants from the National Heart, Lung, and Blood Institute, National Institutes of Health during the conduct of the study. Dr Nash reported grants from the National Institutes of Health during the conduct of the study; and personal fees from AbbVie and Gilead outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Prevalence of Hypertension, Total Cardiovascular Disease (CVD), and CVD Subtypes by Social Vulnerability Index–Haiti (SVI-H) Quartile
HF indicates heart failure; MI, myocardial infarction; TIA, transient ischemic attack. Error bars represent 95% CI.
Figure 2.
Figure 2.. Prevalence of Hypertension, Total Cardiovascular Disease (CVD), and Heart Failure in Social Vulnerability Index–Haiti (SVI-H) Quartile 4 vs SVI-H Quartile 1, Stratified by Age and Sex
Error bars represent 95% CI. aDifference is statistically significant (P < .05).
See this image and copyright information in PMC

Comment on

References

    1. Vos T, Lim SS, Abbafati C, et al. ; GBD 2019 Diseases and Injuries Collaborators . Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204-1222. doi:10.1016/S0140-6736(20)30925-9 - DOI - PMC - PubMed
    1. Zhou B, Carrillo-Larco RM, Danaei G, et al. ; NCD Risk Factor Collaboration (NCD-RisC) . Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet. 2021;398(10304):957-980. doi:10.1016/S0140-6736(21)01330-1 - DOI - PMC - PubMed
    1. Kwan GF, Jean-Baptiste W, Cleophat P, et al. . Descriptive epidemiology and short-term outcomes of heart failure hospitalisation in rural Haiti. Heart. 2016;102(2):140-146. doi:10.1136/heartjnl-2015-308451 - DOI - PMC - PubMed
    1. Kenerson JG. Hypertension in Haiti: the challenge of best possible practice. J Clin Hypertens (Greenwich). 2014;16(2):107-114. doi:10.1111/jch.12242 - DOI - PMC - PubMed
    1. Miranda JJ, Barrientos-Gutiérrez T, Corvalan C, et al. . Understanding the rise of cardiometabolic diseases in low- and middle-income countries. Nat Med. 2019;25(11):1667-1679. doi:10.1038/s41591-019-0644-7 - DOI - PubMed