High Burden of Cardiovascular Disease and Mental Health Illness Comorbidity in Urban Haiti.
People living in low-income settings facing humanitarian crises are at risk for comorbid cardiovascular disease (CVD) and mental health (MH) illness, yet there are limited population-based data available.
We estimated CVD-MH illness comorbidity and associated risk factors using enrollment data from the Haiti Cardiovascular Disease Cohort Study (2019-2021). Adults aged >18 years were recruited using multistage random sampling across Port-au-Prince. Prevalent CVD (hypertension, heart failure, stroke, or myocardial infarction) was adjudicated by a physician panel integrating clinical examinations, imaging, and laboratory data. Prevalent MH illness was defined as depression symptoms (Patient Health Questionnaire 9 score >5) or stress (Perceived Stress Score >5). We conducted multivariable Poisson regression to analyze the association between risk factors (age, sex, low income, education, smoking, alcohol consumption) and the outcome of prevalent CVD-MH illness.
Among 2993 adults in this analysis, the median age was 40 years, 42% were women, and 70% earned an income <1 USD per day. CVD-MH illness comorbidity prevalence was 30% (95% CI, 28-32), with CVD prevalence 34% and MH 85%. In multivariable regression, older age (≥60 versus <40 years; adjusted prevalence ratio, 5.79 [95% CI, 4.57-7.38]), female sex (female versus male sex: adjusted prevalence ratio, 1.22 [95% CI, 1.06-1.42]), and lower education (secondary versus primary education: adjusted prevalence ratio, 1.46 [95% CI, 1.24-1.71]) were significantly associated with CVD-MH illness after adjusting for all other factors.
CVD-MH illness comorbidity is highly prevalent in urban Haiti, especially among older adults and women. These findings underscore the need for integrated, contextually adapted approaches to address multimorbidity in crisis-affected low- and middle-income countries.
We estimated CVD-MH illness comorbidity and associated risk factors using enrollment data from the Haiti Cardiovascular Disease Cohort Study (2019-2021). Adults aged >18 years were recruited using multistage random sampling across Port-au-Prince. Prevalent CVD (hypertension, heart failure, stroke, or myocardial infarction) was adjudicated by a physician panel integrating clinical examinations, imaging, and laboratory data. Prevalent MH illness was defined as depression symptoms (Patient Health Questionnaire 9 score >5) or stress (Perceived Stress Score >5). We conducted multivariable Poisson regression to analyze the association between risk factors (age, sex, low income, education, smoking, alcohol consumption) and the outcome of prevalent CVD-MH illness.
Among 2993 adults in this analysis, the median age was 40 years, 42% were women, and 70% earned an income <1 USD per day. CVD-MH illness comorbidity prevalence was 30% (95% CI, 28-32), with CVD prevalence 34% and MH 85%. In multivariable regression, older age (≥60 versus <40 years; adjusted prevalence ratio, 5.79 [95% CI, 4.57-7.38]), female sex (female versus male sex: adjusted prevalence ratio, 1.22 [95% CI, 1.06-1.42]), and lower education (secondary versus primary education: adjusted prevalence ratio, 1.46 [95% CI, 1.24-1.71]) were significantly associated with CVD-MH illness after adjusting for all other factors.
CVD-MH illness comorbidity is highly prevalent in urban Haiti, especially among older adults and women. These findings underscore the need for integrated, contextually adapted approaches to address multimorbidity in crisis-affected low- and middle-income countries.
Authors
Yan Yan, Metz Metz, Sufra Sufra, St Sauveur St Sauveur, Celestin Celestin, Hilaire Hilaire, Marcellin Marcellin, Auguste Auguste, Ogyu Ogyu, Bennett Bennett, Koenig Koenig, Reif Reif, Dévieux Dévieux, Deschamps Deschamps, Pape Pape, Rouzier Rouzier, McNairy McNairy
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