Urbanization, Altitude and Cardiovascular Risk

Antonio Bernabe-Ortiz; Rodrigo M. Carrillo-Larco

doi:10.5334/gh.1130

Figures & Tables

Table 1

Description of the study population by urbanization: Comparison taking into account multi-stage design.

	URBAN	RURAL	P-VALUE
	(N = 49,687)	(N = 30,722)	P-VALUE
Age			<0.001
40 – 49 years	22,001 (38.8%)	11,630 (34.5%)
50 – 59 years	14,326 (30.2%)	9,104 (30.6%)
60 – 69 years	10,072 (23.0%)	7,119 (24.8%)
70+ years	3,288 (8.0%)	2,869 (10.1%)
Sex			<0.001
Male	22,781 (44.7%)	14,988 (48.0%)
Female	26,906 (55.3%)	15,734 (52.0%)
Education			<0.001
<7 years	13,109 (24.5%)	18,211 (70.5%)
7 – 11 years	18,742 (39.7%)	6,492 (22.7%)
12+ years	16,166 (35.8%)	1,932 (6.8%)
Wealth index			<0.001
First quintile	3,086 (4.2%)	14,731 (49.4%)
Second quintile	4,418 (6.8%)	11,499 (36.0%)
Third quintile	10,599 (19.1%)	2,952 (9.2%)
Fourth quintile	14,512 (31.9%)	1,074 (3.7%)
Fifth quintile	17,072 (38.0%)	466 (1.7%)
Current smoking			0.72
No	42,035 (85.3%)	25,720 (85.5%)
Yes	7,652 (14.7%)	5,002 (14.5%)
Alcohol use			<0.001
No	32,500 (65.1%)	23,092 (75.2%)
Yes	17,159 (34.9%)	7,609 (24.8%)
Hypertension			<0.001
No	34,536 (66.3%)	23,237 (74.7%)
Yes	15,151 (33.7%)	7,485 (25.3%)
Survey year			<0.001
2014	7,043 (11.8%)	4,867 (14.5%)
2015	7,256 (14.8%)	4,170 (15.7%)
2016	7,252 (14.2%)	4,226 (15.1%)
2017	7,366 (15.7%)	4,511 (14.7%)
2018	7,864 (16.6%)	4,681 (15.2%)
2019	7,518 (16.0%)	4,877 (14.9%)
2020	5,388 (10.9%)	3,390 (9.9%)

Table 2

Description of the study population by altitude: Comparison taking into account multi-stage design.

	ALTITUDE (METERS ABOVE SEA LEVEL)				P-VALUE
	<500	500 – 2499	2500 – 3499	≥3500
	(N = 38,188)	(N = 16,198)	(N = 15,301)	(N = 10,722)
Age					<0.001
40 – 49 years	16,338 (38.3%)	7,123 (38.8%)	6,245 (36.9%)	3,925 (34.0%)
50 – 59 years	11,362 (30.2%)	4,645 (30.4%)	4,316 (30.5%)	3,107 (30.5%)
60 – 69 years	8,001 (23.5%)	3,261 (22.4%)	3,335 (22.9%)	2,594 (25.2%)
70+ years	2,487 (8.0%)	1,169 (8.4%)	1,405 (9.7%)	1,096 (10.3%)
Sex					<0.001
Male	18,266 (46.0%)	7,844 (47.2%)	6,870 (43.3%)	4,789 (43.7%)
Female	19,922 (54.0%)	8,354 (52.8%)	8,431 (56.7%)	5,933 (56.3%)
Education					<0.001
<7 years	11,552 (25.8%)	6,719 (44.4%)	7,461 (52.4%)	5,588 (60.0%)
7 – 11 years	14,886 (40.6%)	4,630 (30.5%)	3,361 (25.3%)	2,357 (25.9%)
12+ years	10,464 (33.6%)	3,764 (25.1%)	2,643 (22.3%)	1,227 (14.1%)
Wealth index					<0.001
First quartile	4,273 (6.3%)	3,684 (22.5%)	5,445 (31.1%)	4,415 (41.0%)
Second quartile	4,496 (7.5%)	3,161 (19.1%)	4,552 (26.3%)	3,708 (30.7%)
Third quartile	7,489 (17.6%)	2,804 (16.8%)	2,075 (14.9%)	1,183 (12.6%)
Fourth quartile	10,069 (30.9%)	3,067 (20.0%)	1,720 (14.9%)	730 (8.0%)
Fifth quartile	11,861 (37.7%)	3,482 (21.6%)	1,509 (12.8%)	686 (7.7%)
Current smoking					<0.001
No	31,748 (84.8%)	13,827 (85.5%)	13,138 (87.0%)	9,042 (86.4%)
Yes	6,440 (15.2%)	2,371 (14.5%)	2,163 (13.0%)	1,680 (13.6%)
Alcohol use					<0.001
No	24,903 (64.5%)	11,433 (70.6%)	10,917 (71.4%)	8,339 (77.2%)
Yes	13,259 (35.5%)	4,756 (29.4%)	4,379 (28.6%)	2,374 (22.8%)
Hypertension					<0.001
No	26,208 (65.4%)	11,664 (69.9%)	11,582 (74.4%)	8,319 (76.4%)
Yes	11,980 (34.6%)	4,534 (30.1%)	3,719 (25.6%)	2,403 (23.6%)
Survey year					0.21
2014	5,547 (12.1%)	2,204 (11.9%)	2,301 (13.4%)	1,858 (14.8%)
2015	5,616 (14.8%)	2,345 (15.5%)	2,069 (15.0%)	1,396 (15.7%)
2016	5,513 (14.2%)	2,455 (15.4%)	2,118 (14.6%)	1,392 (14.6%)
2017	5,610 (15.5%)	2,501 (15.9%)	2,244 (14.6%)	1,522 (15.1%)
2018	5,972 (16.4%)	2,476 (15.8%)	2,404 (16.2%)	1,693 (15.9%)
2019	5,751 (16.1%)	2,421 (15.0%)	2,506 (16.0%)	1,717 (14.5%)
2020	4,179 (10.9%)	1,796 (10.5%)	1,659 (10.2%)	1,144 (9.4%)

Table 3

Description of the study population by cardiovascular risk: Comparison taking into account multi-stage design.

	10-YEAR CARDIOVASCULAR RISK		P-VALUE
	LOW (<10%)	HIGH (≥10%)
	(N = 75,218)	(N = 5,191)
Age			<0.001
40 – 49 years	33,609 (54.5%)	22 (4.2%)
50 – 59 years	23,147 (36.4%)	283 (18.2%)
60 – 69 years	15,240 (9.0%)	1,951 (52.0%)
70+ years	3,222 (0.1%)	2,935 (25.5%)
Sex			<0.001
Male	33,902 (43.3%)	3,867 (72.7%)
Female	41,316 (56.7%)	1,324 (27.3%)
Education			<0.001
<7 years	28,885 (34.5%)	2,435 (43.6%)
7 – 11 years	23,973 (36.2%)	1,261 (30.5%)
12+ years	17,200 (29.3%)	898 (25.9%)
Wealth index			<0.001
First quintile	16,668 (15.8%)	1,149 (14.0%)
Second quintile	14,945 (14.4%)	972 (12.4%)
Third quintile	12,794 (16.7%)	757 (15.5%)
Fourth quintile	14,554 (24.6%)	1,032 (25.9%)
Fifth quintile	16,257 (28.5%)	1,281 (32.2%)
Current smoking			<0.001
No	64,198 (86.5%)	3,557 (71.8%)
Yes	11,020 (13.5%)	1,634 (28.2%)
Alcohol use			0.20
No	51,977 (67.5%)	3,615 (69.0%)
Yes	23,198 (32.5%)	1,570 (31.0%)
Hypertension			<0.001
No	56,686 (72.7%)	1,087 (18.6%)
Yes	18,532 (27.3%)	4,104 (81.4%)
Survey year			0.07
2014	10,981 (12.4%)	929 (13.0%)
2015	10,780 (15.2%)	646 (12.9%)
2016	10,790 (14.5%)	688 (14.1%)
2017	11,057 (15.3%)	820 (16.8%)
2018	11,773 (16.2%)	772 (16.6%)
2019	11,616 (15.7%)	779 (16.2%)
2020	8,221 (10.7%)	557 (10.4%)

Table 4

Association between urbanization, altitude and cardiovascular risk: Crude and adjusted models.

Models were built taking into account the multi-stage design of the surveys.

	10-YEAR CARDIOVASCULAR RISK
	LOW (<10%)	HIGH (≥10%)	CRUDE MODEL	ADJUSTED MODEL*
	(N = 66,997)	(N = 4,634)	PR (95% CI)	PR (95% CI)
Urbanization and altitude in different models
*Urbanization*
Urban	46,386 (91.8%)	3,301 (8.2%)	1 (Reference)	1 (Reference)
Rural	28,832 (93.4%)	1,890 (6.6%)	0.80 (0.74 – 0.86)	0.82 (0.75 – 0.89)
*Altitude*
<500 m.a.s.l.	35,546 (91.5%)	2,642 (8.5%)	1 (Reference)	1 (Reference)
500 – 2,499 m.a.s.l.	15,170 (92.5%)	1,028 (7.5%)	0.87 (0.79 – 0.97)	0.95 (0.87 – 1.03)
2,500 – 3,499 m.a.s.l.	14,382 (93.5%)	919 (6.5%)	0.77 (0.69 – 0.85)	0.81 (0.74 – 0.88)
≥3,500 m.a.s.l.	10,120 (94.4 %)	602 (5.6%)	0.66 (0.59 – 0.74)	0.66 (0.59 – 0.73)
Urbanization and altitude in the same model
*Urbanization*
Urban			1 (Reference)	1 (Reference)
Rural			0.91 (0.84 – 0.99)	0.89 (0.81 – 0.97)
*Altitude*
<500 m.a.s.l.			1 (Reference)	1 (Reference)
500 – 2,499 m.a.s.l.			0.90 (0.81 – 0.99)	0.96 (0.89 – 1.05)
2,500 – 3,499 m.a.s.l.			0.80 (0.72 – 0.88)	0.82 (0.75 – 0.90)
≥3,500 m.a.s.l.			0.69 (0.62 – 0.78)	0.68 (0.60 – 0.76)

[i] * Adjusted by age, sex, education, wealth index, and survey year.

Table 5

Association between altitude and cardiovascular risk by urbanization: Crude and adjusted models.