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  • 1
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    Spectrum of prevalent cardiovascular diseases in urban Port-au-Prince, Haiti: a population-based cross-sectional study
    Elsevier BV ; 2024
    In:  The Lancet Regional Health - Americas Vol. 33 ( 2024-05), p. 100729-
    Details
    In: The Lancet Regional Health - Americas, Elsevier BV, Vol. 33 ( 2024-05), p. 100729-
    Type of Medium: Online Resource
    ISSN: 2667-193X
    URL: Article
    DOI: 10.1016/j.lana.2024.100729
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2024
    detail.hit.zdb_id: 3096925-6
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  • 2
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    The relationship between perceived stress and support with blood pressure in urban Haiti: A cross-sectional analysis
    Public Library of Science (PLoS) ; 2022
    In:  PLOS Global Public Health Vol. 2, No. 5 ( 2022-5-2), p. e0000263-
    Details
    In: PLOS Global Public Health, Public Library of Science (PLoS), Vol. 2, No. 5 ( 2022-5-2), p. e0000263-
    Abstract: Haiti is a low-income country whose population lives under repeated and chronic stress from multiple natural disasters, civil unrest, and extreme poverty. Stress has been associated with cardiovascular (CVD) risk factors including hypertension, and the impact of stress on blood pressure may be moderated by support. The distribution of stress, support, and their association with blood pressure has not been well described in low-income countries. We measured stress and support using validated instruments on cross-sectional enrollment data of a population-based cohort of 2,817 adults living in Port-au-Prince, Haiti between March 2019 and April 2021. Stress was measured using the Perceived Stress Scale, while support was measured using the Multidimensional Scale of Perceived Social Support. Continuous scores were categorized into three groups for stress (low (1–5), moderate (6–10), high (11–16), and five groups for support (low (7–21), low-moderate (22–35), moderate (36–49), moderate-high (50–64), high (65–77)). Linear regression models were used to quantify the associations between: 1) support and stress adjusting for age and sex, and 2) stress and blood pressure adjusting for age and sex. A moderation analysis was conducted to assess if support moderated the relationship between stress and blood pressure. The cohort included 59.7% females and the median age was 40 years (IQR 28–55). The majority had an income 〈 1 US dollar per day. The median stress score was moderate (8 out of 16 points, IQR 6–10), and median support score was moderate to high (61 out of 77 points, IQR 49–71). Stress was higher with older ages (60+ years versus 18–29 years: +0.79 points, 95% CI 0.51 to 1.08) and in females (+0.85 points, 95% CI +0.65 to +1.06). Support was higher in males (+3.29 points, 95% CI 2.19 to 4.39). Support was inversely associated with stress, adjusting for age and sex (-0.04 points per one unit increase in support, 95% CI -0.04 to -0.03). Stress was not associated with systolic or diastolic blood pressure after adjustment for age and sex. Support did not moderate the association between stress and blood pressure. In this urban cohort of Haitian adults living with chronic civil instability and extreme poverty, perceived levels of stress and social support were moderate and high, respectively. Contrary to prior literature, we did not find an association between stress and blood pressure. While support was associated with lower stress, it did not moderate the relationship between stress and blood pressure. Participants reported high levels of support, which may be an underutilized resource in reducing stress, potentially impacting health behaviors and outcomes.
    Type of Medium: Online Resource
    ISSN: 2767-3375
    URL: Article
    URL: Article
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    URL: Article
    DOI: 10.1371/journal.pgph.0000263
    DOI: 10.1371/journal.pgph.0000263.g001
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    DOI: 10.1371/journal.pgph.0000263.s001
    DOI: 10.1371/journal.pgph.0000263.s002
    Language: English
    Publisher: Public Library of Science (PLoS)
    Publication Date: 2022
    detail.hit.zdb_id: 3101394-6
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  • 3
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    Comparison of community and clinic-based blood pressure measurements: A cross-sectional study from Haiti
    Public Library of Science (PLoS) ; 2022
    In:  PLOS Global Public Health Vol. 2, No. 9 ( 2022-9-30), p. e0001064-
    Details
    In: PLOS Global Public Health, Public Library of Science (PLoS), Vol. 2, No. 9 ( 2022-9-30), p. e0001064-
    Abstract: Hypertension (HTN) is the leading modifiable cardiovascular disease (CVD) risk factor in low and middle-income countries, and accurate and accessible blood pressure (BP) measurement is essential for identifying persons at risk. Given the convenience and increased use of community BP screening programs in low-income settings, we compared community and clinic BP measurements for participants in the Haiti CVD Cohort Study to determine the concordance of these two measurements. Participants were recruited using multistage random sampling from March 2019 to August 2021. HTN was defined as systolic BP (SBP) ≥ 140mmHg, diastolic BP (DBP) ≥ 90mmHg or taking antihypertensives according to WHO guidelines. Factors associated with concordance versus discordance of community and clinic BP measurements were assessed with multivariable Poisson regressions. Among 2,123 participants, median age was 41 years and 62% were female. Pearson correlation coefficients for clinic versus community SBP and DBP were 0.78 and 0.77, respectively. Using community BP measurements, 36% of participants screened positive for HTN compared with 30% using clinic BPs. The majority of participants had concordant measurements of normotension (59%) or HTN (26%) across both settings, with 4% having isolated elevated clinic BP (≥140/90 in clinic with normal community BP) and 10% with isolated elevated community BP (≥140/90 in community with normal clinic BP). These results underscore community BP measurements as a feasible and accurate way to increase HTN screening and estimate HTN prevalence for vulnerable populations with barriers to clinic access.
    Type of Medium: Online Resource
    ISSN: 2767-3375
    URL: Article
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    DOI: 10.1371/journal.pgph.0001064
    DOI: 10.1371/journal.pgph.0001064.g001
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    DOI: 10.1371/journal.pgph.0001064.s001
    Language: English
    Publisher: Public Library of Science (PLoS)
    Publication Date: 2022
    detail.hit.zdb_id: 3101394-6
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  • 4
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    Abstract 168: Population-based Epidemiology Of Heart Failure In A Low-income Country: The Haiti Cardiovascular Disease Study
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation: Cardiovascular Quality and Outcomes Vol. 15, No. Suppl_1 ( 2022-05)
    Details
    In: Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 15, No. Suppl_1 ( 2022-05)
    Abstract: Aims: Modeling estimates indicate that heart failure (HF) prevalence may be lowest in low-income (LICs). Conversely, HF has been shown to be the leading cause of hospital admission in hospitals in many LICs. This disconnect between estimates and hospital-based observations may be explained by the underlying data. Modeling studies may have selection bias reporting data on individuals presenting with symptomatic disease and may introduce ascertainment bias based on accessibility of care and other structural factors in these communities. Population-based studies are needed to identify the true clinical epidemiology of HF in order to improve HF-related health outcomes in these under-resourced settings where four billion persons live. Haiti is the poorest, most under-resourced country in the Western Hemisphere. We describe HF prevalence, survival, subtypes, risk factors, and one-year mortality in the population-based Haiti Cardiovascular Disease Study. Methods and Results: Multistage cluster-area random sampling identified 2,981 adults, who completed standardized history and exam, laboratory measures, and cardiac imaging. Kaplan-Meier and Cox proportional hazard regression assessed survival; logistic regression identified associated factors. Median follow-up was 15.4 months (IQR 9-22). Age-standardized HF prevalence was 3.2% (93/2,981 [CI:2.6-3.9]). One-year HF mortality was 6.6% versus 0.8% (HR: 7.7 [CI 2.9-20.6] , p 〈 0.0001). The average age of participants with HF was 57 years (IQR 45-65). The first significant increase in HF prevalence occurred between 30-39 and 40-49-years (1.1% vs 3.7%, p=0.003). Age, hypertension, body-mass-index, poverty and renal dysfunction were associated with HF. 44.1% (41/93) of participants with HF were aware of their diagnosis. HFpEF was the most common HF subtype (71.0%). Conclusion: The age-standardized prevalence of HF in this low-income setting was alarmingly high at 3.2%--50% higher than rates in high-income countries and 5-fold higher than modeling estimates for LMICs. Adults with HF were two decades younger as compared to high-income settings and 7.7 times more likely to die at one year. These data serve as a warning sign and may have implications for policy makers and future HF interventions in LMICs.
    Type of Medium: Online Resource
    ISSN: 1941-7713 , 1941-7705
    URL: Article
    DOI: 10.1161/circoutcomes.15.suppl_1.168
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2453882-6
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  • 5
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    Image_1.TIFF
    Frontiers Media SA ; 2022
    In:  Frontiers in Public Health Vol. 10 ( 2022-10-5)
    Details
    In: Frontiers in Public Health, Frontiers Media SA, Vol. 10 ( 2022-10-5)
    Abstract: Obesity is associated with increased risk of non-communicable diseases and death and is increasing rapidly in low- and middle-income countries, including Haiti. There is limited population-based data on body mass index (BMI) and waist circumference (WC) and associated risk factors in Haiti. This study describes BMI and WC, and factors associated with obesity using a population-based cohort from Port-au-Prince. Methods Baseline sociodemographic and clinical data were collected from participants in the Haiti CVD Cohort Study between March 2019 and August 2021. Weight was categorized by BMI (kg/m 2 ) with obesity defined as ≥30 kg/m 2 . Abdominal obesity was defined using WC cutoffs of ≥80 cm for women and ≥94 cm for men based on WHO guidelines. Sociodemographic and behavioral risk factors, including age, sex, educational attainment, income, smoking status, physical activity, fat/oil use, daily fruit/vegetable consumption, and frequency of fried food intake were assessed for their association with obesity using a Poisson multivariable regression. Results Among 2,966 participants, median age was 41 years (IQR: 28–55) and 57.6% were women. Median BMI was 24.0 kg/m 2 (IQR: 20.9–28.1) and 508 (17.1%) participants were obese. Women represented 89.2% of the population with BMI ≥30 kg/m 2 . A total of 1,167 (68.3%) women had WC ≥80 cm and 144 (11.4%) men had WC ≥94 cm. BMI ≥30 kg/m 2 was significantly more prevalent among women than men [PR 5.7; 95% CI: (4.3–7.6)], those 40–49 years compared to 18–29 years [PR 3.3; 95% CI: (2.4–4.6)] , and those with income & gt;10 USD per day compared to ≤1 USD [PR 1.3; 95% CI: (1.0–1.6)]. There were no significant associations with other health and behavioral risk factors. Discussion In Haiti, women have an alarming 6-fold higher obesity prevalence compared to men (26.5 vs. 4.3%) and 89.2% of participants with obesity were women. Abdominal obesity was high, at 44.3%. Haiti faces a paradox of an ongoing national food insecurity crises and a burgeoning obesity epidemic. Individual, social, and environmental drivers of obesity, especially among women, need to be identified.
    Type of Medium: Online Resource
    ISSN: 2296-2565
    URL: Article
    URL: Article
    DOI: 10.3389/fpubh.2022.976909
    DOI: 10.3389/fpubh.2022.976909.s001
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2022
    detail.hit.zdb_id: 2711781-9
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  • 6
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    Frontiers Media SA ; 2022
    In:  Frontiers in Endocrinology Vol. 13 ( 2022-2-24)
    Details
    In: Frontiers in Endocrinology, Frontiers Media SA, Vol. 13 ( 2022-2-24)
    Abstract: Diabetes mellitus is a chronic noncommunicable disease associated with death and major disability, with increasing prevalence in low- and middle-income countries. There is limited population-based data about diabetes in Haiti. The objective of this study was to assess the prevalence of diabetes and associated factors among adults in Port-au-Prince, Haiti using a population-based cohort. Methods This study analyzes cross-sectional enrollment data from the population-based Haiti Cardiovascular Disease Cohort Study, conducted using multistage sampling with global positioning system waypoints in census blocks in the metropolitan area of Port-au-Prince, Haiti. A total of 3,005 adults ≥18 years old were enrolled from March 2019 to August 2021. We collected socio-demographic data, health-related behaviors, and clinical data using standardized questionnaires. Diabetes was defined as any of the following criteria: enrollment fasting glucose value ≥ 126 mg/dL or non-fasting glucose ≥ 200 mg/dL, patient self-report of taking diabetes medications, or study physician diagnosis of diabetes based on clinical evaluation. Results Among 2985 (99.3%) with complete diabetes data, median age was 40 years, 58.1% were female, and 17.2% were obese. The prevalence of diabetes was 5.4% crude, and 5.2% age standardized. In unadjusted analysis, older age, higher body mass index (BMI), low physical activity, low education were associated with a higher odds of diabetes. After multivariable logistic regression, older age [60+ vs 18-29, Odds Ratio (OR)17.7, 95% CI 6.6 to 47.9] and higher BMI (obese vs normal/underweight, OR 2.7, 95% CI 1.7 to 4.4) remained statistically significantly associated with higher odds of diabetes. Conclusion The prevalence of diabetes was relatively low among adults in Port-au-Prince, but much higher among certain groups (participants who were older and obese). The Haitian health system should be strengthened to prevent, diagnose, and treat diabetes among high-risk groups.
    Type of Medium: Online Resource
    ISSN: 1664-2392
    URL: Article
    URL: Article
    DOI: 10.3389/fendo.2022.841675
    DOI: 10.3389/fendo.2022.841675.s001
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2022
    detail.hit.zdb_id: 2592084-4
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  • 7
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    Extreme Food Insecurity and Malnutrition in Haiti: Findings from a Population-Based Cohort in Port-au-Prince, Haiti
    MDPI AG ; 2022
    In:  Nutrients Vol. 14, No. 22 ( 2022-11-17), p. 4854-
    Details
    In: Nutrients, MDPI AG, Vol. 14, No. 22 ( 2022-11-17), p. 4854-
    Abstract: Haiti is one of the most food-insecure (FIS) nations in the world, with increasing rates of overweight and obesity. This study aimed to characterize FIS among households in urban Haiti and assess the relationship between FIS and body mass index (BMI) using enrollment data from the Haiti Cardiovascular Disease Cohort Study. FIS was characterized as no/low, moderate/high, and extreme based on the Household Food Security Scale. Multinomial logistic generalized estimating equations were used to evaluate the association between FIS categories and BMI, with obesity defined as BMI ≥ 30 kg/m2. Among 2972 participants, the prevalence of moderate/high FIS was 40.1% and extreme FIS was 43.7%. Those with extreme FIS had higher median age (41 vs. 38 years) and were less educated (secondary education: 11.6% vs. 20.3%) compared to those with no/low FIS. Although all FIS categories had high obesity prevalence, those with extreme FIS compared to no/low FIS (15.3% vs. 21.6%) had the lowest prevalence. Multivariable models showed an inverse relationship between FIS and obesity: moderate/high FIS (OR: 0.77, 95% CI: 0.56, 1.08) and extreme FIS (OR: 0.58, 95% CI: 0.42, 0.81) versus no/low FIS were associated with lower adjusted odds of obesity. We found high prevalence of extreme FIS in urban Haiti in a transitioning nutrition setting. The inverse relationship between extreme FIS and obesity needs to be further studied to reduce both FIS and obesity in this population.
    Type of Medium: Online Resource
    ISSN: 2072-6643
    URL: Article
    DOI: 10.3390/nu14224854
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2518386-2
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  • 8
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    Abstract 04: Neighborhood Social Vulnerability Associated With Increased Hypertension and Cardiovascular Disease in Port-au-Prince: Findings From the Haiti Cardiovascular Disease Cohort Study
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Circulation Vol. 147, No. Suppl_1 ( 2023-02-28)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 147, No. Suppl_1 ( 2023-02-28)
    Abstract: Introduction: Cardiovascular disease (CVD) is the leading cause of mortality in low-income countries (LICs). Neighborhood social vulnerability has been associated with increased CVD risk in high-income countries, but the relationship is unknown in LICs. Our objective was to determine the association between neighborhood social vulnerability and prevalent CVD in urban Haiti. Hypothesis: We hypothesize that adults living in neighborhoods with increased social vulnerability will have a greater prevalence of hypertension (HTN) and CVD. Methods: We used cross-sectional enrollment data from the Haiti CVD Cohort study, a population-based cohort of adults ≥18 years living in Port-au-Prince distributed across 97 census blocks. To quantify vulnerability, we created a Haiti-specific Neighborhood Social Vulnerability Index (NSVI) based on the US CDC Social Vulnerability Index. The NSVI included three socioeconomic variables (income, sex, education), two household variables (single parent household, household with child 〈 18 years), and six neighborhood stress and well-being variables (neighborhood cohesion, neighborhood violence, perceived stress, food insecurity, depression, social support). Each variable was determined using validated questionnaires. NSVI was calculated for each census block, which were stratified into quartiles. HTN was defined as SBP ≥140 mmHg, DBP ≥90, or on antihypertensive medications; CVD included heart failure, stroke, myocardial infarction, and angina, defined using adjudicated criteria. HTN and CVD prevalence were calculated for each NSVI quartile. Associations between NSVI quartile and HTN or CVD were quantified using individual-level multivariate logistic regression to adjust for confounders. Results: Among 2932 participants, median age was 40 years (IQR 28-55) and 58% were female. Age-standardized prevalence of HTN and CVD was 32.3% and 13.8%, respectively. The age-standardized prevalence of HTN and CVD was 35.7% and 17.3% across 4 th NSVI quartile blocks, compared to 29.1% and 14.1% across 1 st quartile NSVI blocks (p 〈 0.001). After adjusting for age, BMI, smoking, and alcohol use, participants living in 4 th NSVI quartile blocks had a greater risk of HTN (Adjusted Odds Ratio (aOR) 1.42; 95% CI 1.07-1.88; p-value 0.01) and CVD (aOR 1.36; CI: 0.99-1.88; p-value 0.06) compared to participants in the 1 st NSVI quartile blocks. NSVI was significantly associated with HTN in males but not females; conversely, NSVI was significantly associated with CVD in females and not males. Conclusions: Individuals living in neighborhoods with the greatest social vulnerability had a higher prevalence of HTN and CVD. Even in a setting of severe poverty such as urban Haiti, gradients in social vulnerabilities are associated with CVD disparities. Screening for social vulnerabilities should be incorporated into CVD prevention and treatment interventions in LICs.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.147.suppl_1.04
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 1466401-X
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  • 9
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    Neighborhood cohesion and violence in Port-au-Prince, Haiti, and their relationship to stress, depression, and hypertension: Findings from the Haiti cardiovascular disease cohort study
    Public Library of Science (PLoS) ; 2022
    In:  PLOS Global Public Health Vol. 2, No. 7 ( 2022-7-27), p. e0000503-
    Details
    In: PLOS Global Public Health, Public Library of Science (PLoS), Vol. 2, No. 7 ( 2022-7-27), p. e0000503-
    Abstract: Neighborhood factors have been associated with health outcomes, but this relationship is underexplored in low-income countries like Haiti. We describe perceived neighborhood cohesion and perceived violence using the Neighborhood Collective Efficacy and the City Stress Inventory scores. We hypothesized lower cohesion and higher violence were associated with higher stress, depression, and hypertension. We collected data from a population-based cohort of adults in Port-au-Prince, Haiti between March 2019 to August 2021, including stress (Perceived Stress Scale), depression (PHQ-9), and blood pressure (BP). Hypertension was defined as systolic BP ≥ 140 mmHg, diastolic BP ≥ 90 mmHg, or on antihypertensive medications. Covariates that were adjusted for included age, sex, body mass index, smoking, alcohol, physical activity, diet, income, and education, multivariable linear and Poisson regressions assessed the relationship between exposures and outcomes. Among 2,961 adults, 58.0% were female and median age was 40 years (IQR:28–55). Participants reported high cohesion (median 15/25, IQR:14–17) and moderate violence (9/20, IQR:7–11). Stress was moderate (8/16) and 12.6% had at least moderate depression (PHQ-9 ≥11). Median systolic BP was 118 mmHg, median diastolic BP 72 mmHg, and 29.2% had hypertension. In regressions, higher violence was associated with higher prevalence ratios of moderate-to-severe depression (Tertile3 vs Tertile1: PR 1.12, 95%CI:1.09 to 1.16) and stress (+0.3 score, 95%CI:0.01 to 0.6) but not hypertension. Cohesion was associated with lower stress (Tertile3 vs Tertile1: -0.4 score, 95%CI: -0.7 to -0.2) but not depression or hypertension. In summary, urban Haitians reported high perceived cohesion and moderate violence, with higher violence associated with higher stress and depression.
    Type of Medium: Online Resource
    ISSN: 2767-3375
    URL: Article
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    DOI: 10.1371/journal.pgph.0000503
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    DOI: 10.1371/journal.pgph.0000503.r001
    DOI: 10.1371/journal.pgph.0000503.r002
    DOI: 10.1371/journal.pgph.0000503.r003
    Language: English
    Publisher: Public Library of Science (PLoS)
    Publication Date: 2022
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  • 10
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    Abstract P559: Evaluating Geographic Variation in Hypertension in Urban Haiti: Findings From the Haiti Cardiovascular Disease Cohort Study
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Circulation Vol. 147, No. Suppl_1 ( 2023-02-28)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 147, No. Suppl_1 ( 2023-02-28)
    Abstract: Introduction: Hypertension (HTN) is the leading cardiovascular risk factor in low-income countries including Haiti. Understanding blood pressure (BP) variation at the individual, neighborhood and population levels may help target interventions for multi-level risk reduction. This study aims to identify systolic BP (SBP) and diastolic BP (DBP) variation by neighborhood census blocks in Port-au-Prince to determine if this level should be targeted for future HTN interventions. Methods: Using data from the Haiti Cardiovascular Disease Cohort (March 2019-August 2021), a population-based cohort of Haitians ≥ 18 years, HTN was defined as SBP ≥140 mmHg or DBP ≥80 mmHg. Census blocks were defined as geographic areas of approximately 100-200 residential buildings per the Haitian Institute of Statistics. The geographic distribution of SBP and DBP was mapped based on household location. The proportion of SBP and DBP variation in block membership was calculated using intra-class correlations (ICC) from linear mixed models. Results: Among 2,972 participants, median (IQR) age was 40 (28-55) years and 57.6% were female. HTN prevalence was 33.0% and median (IQR) SBP and DBP were 120 (108-140) mmHg and 73.0 (64.0-85.0) mmHg, respectively. No distinct geographic pattern was present for SBP or DBP across blocks (Figure 1). The variation of SBP was 0.7% and DBP was 1.0% across census block membership. Conclusion: HTN prevalence in urban Port-au-Prince is high without a significant variation in SBP and DBP by census block. This may be due to outdated census data, crossover of individuals living informally across households, and/or the need for different household-level neighborhood geographic constructs such as shared household units. Moreover, these data suggest that interventions may need to target the population level, which span neighborhoods, given the uniformity of hypertension across these communities in Port-au-Prince.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.147.suppl_1.P559
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 1466401-X
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