Cardiometabolic Risk Factors Among Rural and Non-Rural Adults in Nepal

Abstract

University of Washington Abstract Cardiometabolic Risk Factors Among Rural and Non-Rural Adults in Nepal Biraj Neupane Chair of the Supervisory Committee: Annette L. Fitzpatrick, PhD Department of Epidemiology Disparities in cardiometabolic diseases, including heart disease, stroke, diabetes, and kidney disease, have been documented globally across socioeconomic status. While decreasing in high-income nations, cardiovascular disease (CVD) mortality and noncommunicable disease (NCD) prevalence have increased in low- and middle-income countries (LMICs). The burden of cardiometabolic disorders remains a major concern in Nepal where their distribution in rural and urban areas are poorly understood. We combined data from the Dhulikhel Heart Study (DHS), an observational cohort study representing an urban setting, and the Personalized Health Program (PHP), which collected similar data in four rural regions, to compare the prevalence of selected risk factors for cardiometabolic disease by rural/urban setting in Nepalese adults. We assessed the associations between two outcomes, overweight/obesity and hypertension, with rural/urban residency and selected demographic and lifestyle characteristics of the sample. The data from DHS (N=1061) and PHP (N=3288) were harmonized to provide variables with the same values. Overweight/obesity was defined as BMI > 25 and hypertension was defined as systolic blood pressure > 140 or diastolic blood pressure > 90. Covariates included age, gender, ethnicity, education, marital status, smoking, alcohol use, and physical activity. Multivariable logistic regression was used to evaluate the odds of increased overweight/obesity and hypertension by rural/urban setting adjusted for potential confounders. In adjusted models, living in an urban setting increased the odds of being overweight/obese two-fold (OR:2.14, 95% CI: 1.57-2.93, p<0.001). Increased age, female gender, higher education, being married, Newar ethnicity, and current consumption of alcohol were significant association with being overweight/obese. The odds of having hypertension were also doubled for urban residents (OR:2.12, 95% CI:1.55-2.90, p< 0.001) adjusted for demographic and lifestyle. Gender, age, education, marital status, ethnicity, and physical activity were also significantly associated with hypertension. These results provide insights into the distribution and impact of behavioral and lifestyle-related risk factors on cardiometabolic conditions in different settings in Nepal. The findings may be used to inform targeted interventions and tailored healthcare approaches to address the specific challenges faced by each population.