Temporal trends in cardiovascular disease risk factors among white, South Asian, Chinese and black groups in Ontario, Canada, 2001 to 2012: a population-based study

Maria Chiu, Laura C Maclagan, Jack V Tu, Baiju R Shah, Maria Chiu, Laura C Maclagan, Jack V Tu, Baiju R Shah

Abstract

Objectives: To determine ethnic-specific temporal trends in cardiovascular risk factors in Ontario between 2001 and 2012.

Design: A population-based repeated cross-sectional study.

Setting: Ontario, Canada.

Participants: 219,276 participants of the Canadian Community Health Survey (205,326 white, 5620 South Asian, 4368 Chinese and 3962 black) during the period 2001 to 2012.

Main outcome measures: Age-standardised ethnic-sex-specific prevalence of cardiovascular risk factors for three time periods: 2001-2004, 2005-2008 and 2009-2012 among Canada's four major ethnic groups: white, South Asian, Chinese and black.

Results: During the study period, the prevalence of diabetes increased 2.3-fold (p = 0.0001) among South Asian males and 1.9-fold (p = 0.02) among black females. The prevalence of obesity (body mass index ≥ 30 kg/m(2)) increased over time across all ethnic groups, with the largest relative increases observed among males of Chinese (2.1-fold increase, p = 0.04) and black (1.7-fold increase, p = 0.06) descent. The prevalence of hypertension increased the most among black females. Smoking prevalence decreased by more than 20% among South Asian, Chinese and white females. Overall, South Asian males and black males and females showed the greatest declines in cardiovascular health over the study period.

Conclusions: We observed important ethnic differences in the temporal trends in cardiovascular risk factor profiles in Ontario. Awareness of the direction and magnitude of these risk factor trends may be useful in informing targeted strategies for preventing cardiovascular diseases in multiethnic populations.

Keywords: CARDIOLOGY; EPIDEMIOLOGY; PREVENTIVE MEDICINE; PUBLIC HEALTH.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

Figure 1
Figure 1
Temporal trends in the prevalence (%) of major cardiovascular risk factors, by ethnicity. Data were derived from the Ontario components of Statistics Canada's Canadian Community Health Surveys. Estimates were age- and sex-standardised to the 2001 Ontario Census population and weighted by the survey sample weight. Percent changes ∆ are reported for 2009-2012 vs. 2001-2004; i.e. [(estimate for 2009-2012 - estimate for 2001-2004)/(estimate for 2001-2004)]*100. Bootstrap methods were used to derive p values comparing estimates for 2009-2012 to estimates for 2001-2004. Definition: Obesity, body-mass index≥30 kg/m2. *p<0.05.
Figure 2
Figure 2
Temporal trends in age- and sex-standardised prevalence of overweight/obesity, by ethnicity and sex. Data were derived from the Ontario components of Statistics Canada's Canadian Community Health Surveys. Estimates were age- and sex-standardised to the 2001 Ontario Census population using 5-year age categories, and weighted by the survey sample weight. Definitions: Overweight/obesity, body-mass index ≥25 kg/m2; Obesity, body-mass index ≥30kg/m2.
Figure 3
Figure 3
Temporal trends in the prevalence (%) of other cardiovascular risk factors, by ethnicity. Data were derived from the Ontario components of Statistics Canada's Canadian Community Health Surveys. Estimates were age- and sex-standardised to the 2001 Ontario Census population and weighted by the survey sample weight. Percent changes ∆ are reported for 2009-2012 vs. 2001-2004; i.e. [(estimate for 2009-2012 - estimate for 2001-2004) / (estimate for 2001-2004)]*100. Bootstrap methods were used to derive p values comparing estimates for 2009-2012 to estimates for 2001-2004. Definitions: Psychosocial stress ("extremely" or "quite a bit" stressed on most days); inadequate fruit and vegetable intake (

Figure 4

Summary of trends in major…

Figure 4

Summary of trends in major cardiovascular risk factors among males and females by…

Figure 4
Summary of trends in major cardiovascular risk factors among males and females by ethnicity, Ontario, Canada. Data were derived from the Ontario components of Statistics Canada's Canadian Community Health Surveys. Arrows ↑↓ indicate ≥20% increases or decreases in major cardiovascular risk factor prevalences comparing the estimates for 2009-2012 to estimates for 2001-2004. *P
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Figure 4
Figure 4
Summary of trends in major cardiovascular risk factors among males and females by ethnicity, Ontario, Canada. Data were derived from the Ontario components of Statistics Canada's Canadian Community Health Surveys. Arrows ↑↓ indicate ≥20% increases or decreases in major cardiovascular risk factor prevalences comparing the estimates for 2009-2012 to estimates for 2001-2004. *P

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