Urbanization and cardiovascular health among Indigenous groups in Brazil

Anderson da Costa Armstrong; Carlos Dornels Freire de Souza; Juracy Marques Dos Santos; Rodrigo Feliciano do Carmo; Dinani Matoso Fialho de Oliveira Armstrong; Vanessa Cardoso Pereira; Ana Marice Ladeia; Luis Claudio Lemos Correia; Manoel Barral-Netto; Joao Augusto Costa Lima

doi:10.1038/s43856-023-00239-3

Urbanization and cardiovascular health among Indigenous groups in Brazil

Commun Med (Lond). 2023 Feb 2;3(1):17. doi: 10.1038/s43856-023-00239-3.

Authors

Affiliations

¹ Universidade Federal do Vale do Sao Francisco, Petrolina, Pernambuco, Brazil. anderson.armstrong@univasf.edu.br.
² Universidade do Estado da Bahia, Juazeiro, Bahia, Brazil. anderson.armstrong@univasf.edu.br.
³ Universidade Federal do Vale do Sao Francisco, Petrolina, Pernambuco, Brazil.
⁴ Universidade Federal de Alagoas, Arapiraca, Alagoas, Brazil.
⁵ Universidade do Estado da Bahia, Juazeiro, Bahia, Brazil.
⁶ Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil.
⁷ Johns Hopkins University, Baltimore, MD, USA.
⁸ Instituto Gonçalo Moniz - Fundação Oswaldo Cruz (Fiocruz), Salvador, Bahia, Brazil.
⁹ Faculdade de Medicina da Universidade Federal da Bahia, Salvador, Bahia, Brazil.

Abstract

Background: We described the prevalence of cardiovascular risk factors in groups of Brazilian Indigenous people at different degrees of urbanization.

Methods: The Project of Atherosclerosis among Indigenous populations (Projeto de Aterosclerose em Indígenas; PAI) is a cross-sectional study conducted in Northeast Brazil between August 2016-June 2017. It included three populations: Fulni-ô Indigenous people (lowest degree of urbanization), Truká Indigenous people (greater urbanization), and a highly urbanized non-Indigenous local cohort (control group). Participants were assessed to register sociodemographic, anthropometric, as well as clinical and laboratory-derived cardiovascular (CV) risk parameters. Age-adjusted prevalence of hypertension was also computed. Nonparametric tests were used for group comparisons.

Results: Here we included 999 participants, with a predominance of females in all three groups (68.3% Control group, 65.0% Fulni-ô indigenous group, and 60.1% Truká indigenous group). Obesity was present in 45.6% of the urban non-Indigenous population, 37.7% Truká and in 27.6% Fulni-ô participants. The prevalence of hypertension was 29.1% (n = 297) with lower prevalence in the less urbanized Fulni-ô people (Fulni-ô - 18.2%; Truká - 33.9%; and Control - 33.8%; p < 0.001). In the elderly male population, the prevalence of hypertension was 18.7% in the Fulni-ô, 45.8% in the Truká, and 54.5% in the control group. Of the 342 participants that self-reported hypertension, 37.5% (n = 68) showed uncontrolled blood pressure (BP). Uncontrolled BP was more prevalent among Truká people when compared to Fulni-ô people and non-Indigenous participants (45.4%, 22.9%, and 40.7%, respectively; p < 0.001).

Conclusions: We found a higher cardiovascular risk in communities with a higher degree of urbanization, suggesting that living in towns and cities may have a negative impact on these aspects of cardiovascular health.

Plain language summary

The lifestyles and environments of traditional indigenous and city-living communities differ. We compared rates of obesity and hypertension in members of two under-studied Indigenous groups in Northeast Brazil and a nearby urbanized group. We found higher rates of obesity and hypertension amongst members of the more urbanized community, suggesting that living in towns and cities may have a negative impact on these aspects of cardiovascular health. These results suggest those living in the city should modify their lifestyle and monitor their cardiovascular health more carefully if possible.