Sex-and-Gender Differences in Cardiovascular Risk Factors and Their Correlates Among Adults in Freetown, Sierra Leone: A Population-Based Health-Screening Survey

Author(s): James Baligeh Walter Russell, Theresa Ruba Koroma, Sallieu Samura, Abdul Jalloh, Joshua Coker, Mohamed Smith, Durodami Radcliff Lisk

Background:

Sex-and-gender differences are crucial modifiers of cardiovascular health, yet most guidelines in sub-Saharan Africa are not sex-and-gender specific. The aim of the study was to examine the relationship between sex-and-gender differences and the prevalence of traditional cardiovascular risk factors and their correlates in a populationbased cross-sectional study in Sierra Leone.

Methods:

A stratified multistage random sampling technique was employed to recruit 2394 adults aged 20 years and older from October 2021 to October 2023 in Western Area Urban, Sierra Leone. Data collection comprised three components: clinical assessments, self-reported health behaviours, and biochemical measurements, all based on the WHO stepwise approach.

Results:

No significant age differences were observed between genders (females 42.06 ± 12 years vs. males 41.76 ± 12.6 years, p = 0.550). Males showed higher prevalence of hypertension (37.4% vs. 33.4%, p = 0.068), diabetes (9.2% vs. 7.4%, p = 0.101), overweight (34.2% vs. 32.3%, p = 0.323), and obesity (10.2% vs. 9.9%, p = 0.818). Conversely, females had significantly higher Body Mass Index (BMI) [25.0 ± 5.0 vs. 24.6 ± 4.4, p = 0.029], waist circumference (WC) [93.6 ± 4.5 vs. 80.0 ± 5.0, p < 0.001], triglyceride levels [1.7 ± 0.35 vs. 1.6 ± 0.32, p =0.013], total cholesterol [5.1 ± 0.77 vs. 4.9 ± 0.66, p < 0.001], and low HDL-C [1.28 ± 0.29 vs. 1.3 ± 0.24, p = 0.016]. Females also had higher odds of dyslipidaemia [OR=1.339; 95% CI: (1.101-1.629), p=0.003] and alcohol consumption [OR=1.229; 95% CI: (1.026 - 1.472), p=0.025]. Women faced 1.8 times greater odds [AOR=1.849; 95% CI: (0.713 - 1.010), p=0.030] of hypertension, 1.4 times higher odds [AOR=1.441; 95% CI: (1.176 - 1.765), p <0.001] of dyslipidaemia, and 1.2 times greater odds [AOR=1.225; 95% CI: (1.0123 - 1.481), p=0.037] of alcohol use compared to men. In women, BMI, WC, and blood sugar levels showed stronger correlations than in men.

Conclusion:

This study highlights the higher prevalence of cardiovascular risk factors in women in Sierra Leone, indicating the importance of implementing targeted health policies and interventions to reduce these disparities.