Disparities in the non-laboratory INTERHEART risk score and its components in selected countries of Europe and sub-Saharan Africa: analysis from the SPICES multi-country project

Hamid Y Hassen; Steven Abrams; Geofrey Musinguzi; Imogen Rogers; Alfred Dusabimana; Peter M Mphekgwana; Hilde Bastiaens; Scaling-up Packages of Interventions for Cardiovascular diseases in Europe and Sub-Saharan Africa (SPICES) study investigators

doi:10.1093/ehjopen/oead131

Disparities in the non-laboratory INTERHEART risk score and its components in selected countries of Europe and sub-Saharan Africa: analysis from the SPICES multi-country project

Eur Heart J Open. 2023 Dec 5;3(6):oead131. doi: 10.1093/ehjopen/oead131. eCollection 2023 Nov.

Authors

Hamid Y Hassen¹, Steven Abrams^{1

2}, Geofrey Musinguzi^{1

3}, Imogen Rogers⁴, Alfred Dusabimana¹, Peter M Mphekgwana⁵, Hilde Bastiaens¹; Scaling-up Packages of Interventions for Cardiovascular diseases in Europe and Sub-Saharan Africa (SPICES) study investigators

Collaborators

Scaling-up Packages of Interventions for Cardiovascular diseases in Europe and Sub-Saharan Africa (SPICES) study investigators:
Hilde Bastiaens, Hamid Y Hassen, Naomi Aerts, Sibyl Anthierens, Kathleen Van Royen, Caroline Masquillier, Jean Yves Le Reste, Delphine Le Goff, Gabriel Perraud, Harm van Marwijk, Elisabeth Ford, Tom Grice-Jackson, Imogen Rogers, Papreen Nahar, Linda Gibson, Mark Bowyer, Almighty Nkengateh, Geofrey Musinguzi, Rawlance Ndejjo, Fred Nuwaha, Tholene Sodi, Peter M Mphekgwana, Nancy Malema, Nancy Kgatla, Tebogo M Mothiba

Affiliations

¹ Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Doornstraat 331, Wilrijk 2610, Belgium.
² Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Data Science Institute, Hasselt University, Diepenbeek 3590, Belgium.
³ Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda.
⁴ Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK.
⁵ Research Administration and Development, University of Limpopo, Polokwane 0700, South Africa.

Abstract

Aims: Accurate prediction of a person's risk of cardiovascular disease (CVD) is vital to initiate appropriate intervention. The non-laboratory INTERHEART risk score (NL-IHRS) is among the tools to estimate future risk of CVD. However, measurement disparities of the tool across contexts are not well documented. Thus, we investigated variation in NL-IHRS and components in selected sub-Saharan African and European countries.

Methods and results: We used data from a multi-country study involving 9309 participants, i.e. 4941 in Europe, 3371 in South Africa, and 997 in Uganda. Disparities in total NL-IHRS score, specific subcomponents, subcategories, and their contribution to the total score were investigated. The variation in the adjusted total and component scores was compared across contexts using analysis of variance. The adjusted mean NL-IHRS was higher in South Africa (10.2) and Europe (10.0) compared to Uganda (8.2), and the difference was statistically significant (P < 0.001). The prevalence and per cent contribution of diabetes mellitus and high blood pressure were lowest in Uganda. Score contribution of non-modifiable factors was lower in Uganda and South Africa, entailing 11.5% and 8.0% of the total score, respectively. Contribution of behavioural factors to the total score was highest in both sub-Saharan African countries. In particular, adjusted scores related to unhealthy dietary patterns were highest in South Africa (3.21) compared to Uganda (1.66) and Europe (1.09). Whereas, contribution of metabolic factors was highest in Europe (30.6%) compared with Uganda (20.8%) and South Africa (22.6%).

Conclusion: The total risk score, subcomponents, categories, and their contribution to total score greatly vary across contexts, which could be due to disparities in risk burden and/or self-reporting bias in resource-limited settings. Therefore, primary preventive initiatives should identify risk factor burden across contexts and intervention activities need to be customized accordingly. Furthermore, contextualizing the risk assessment tool and evaluating its usefulness in different settings are recommended.

Keywords: Cardiovascular disease; Disparities; Europe; INTERHEART; Risk score; Sub-Saharan Africa.