Risk Prediction and Factors Associated with Cardiovascular Diseases among Workers and their Spouses in Two Beverage Processing Industries in Rwanda

Abstract

Cardiovascular diseases are responsible for 30% of all deaths worldwide and assume 80% of the burden in low and middle-income countries. Although they affect people at large, a big proportion of these diseases afflict people of working age with a great negative impact on premature death, dependencies, and loss of working days. Rwanda in 2008 was in the top region countries with high blood pressure prevalence in the whole African region. This study’s aim was to determine factors associated with cardiovascular diseases predicted risk among workers and spouses of two beverage-processing plants in Rwanda and was conducted under a cross-sectional quantitative research design. The sample size of this study was 440 study participants calculated by the Cochran formula from 822 target population. The study used proportionate stratified random sampling for the sample size of the study where each subgroup was adequately represented. The instruments of this study were the WHO standardized questionnaire and cardiovascular diseases risk prediction models: WHO/ISH and FGRS (Framingham general risk score). The Data was analyzed by SPPS version 22, where a descriptive, bivariate, and multivariate analysis, C-statistic, and Kappa test with 95%CI were applied. The significance was set at p<0.05. Overall risk prediction (<10%) by FGRS and WHO/ISH score were 74.5%, 95.4%, respectively while the CVD elevated risk (>=10%) was 25.5%, 4.6%, respectively. FGRS CVD risk (>= 10%) was 16.1% of males versus 9.3% of females while 2.7% of males versus 1.5% of females classified by WHO/ISH. CVD risk increases in both models with age but very much in FGRS. 8.4% of employees versus 5.2% of spouses are classified as having the risk of 10-20% by FGRS while WHO/ISH classify 2.5% of employees and 0.9% of spouses as having the risk of 10-20%. FGRS classified 11.7% of all participants as having absolute cardiovascular diseases risk above 20% while WHO/ISH classify only 1% as having absolute cardiovascular diseases risk above 20%. Two models’ kappa agreement level was fair or minimal interrater reliability with 0.25 with a p-value < 0.001 and the correlated ROC curve of FGRS and WHO/ISH of 0.887 AUC, 0.847AUC all with a p-value <0.001, respectively. Night shift dominated other working conditions with AOR=2.41(1.27-4.58), p=0.007, and a high level of sedentary (>10hrs) also dominated to be associated with metabolic diseases with crude OR=8.196(2.07-32.3) while its association to CVDs was: OR=3.777(1.7-8.2), hypertension prevalence was 32.27% in the previous classification while it was 61.81% in updated classification, metabolic syndrome prevalence was 38.2%. The use of PPE for Noise and chemicals was negatively correlated with cardiovascular disease risk for both models after Kendall’s tau_b -0.218 p<0.001, -0.157 p=0.004, respectively, and spearman’s rho test-0.244, p<0.001, -0.175, p=0.004, respectively. Noise and vibration and radiation were significantly associated with cardiovascular diseases by Framingham risk score with p<0.05. The three unchangeable factors (Age, Gender, and family history) were associated with CVD risk, p<0.05. The workplace risk factors such as radiation and high stress with AoR=0.36(0.15-0.86), p=0.02 and AoR=21.398(2.65-172.59),p=0.004. The FGRS showed that eight modifiable factors were associated with CVDs while it was only four factors for WHO/ISH. The most prominent factors were diabetes, hypertension, low physical inactivity (<600MET/Week), times exceeded alcohol standards, low fruits, and vegetable intake, and tobacco use. The two novel risks (CRP and HBA1C) were four to fivefold linked with cardiovascular disease risk, p<0.05. Male employees dominated other groups for 10 risk factors. The study conclusion demonstrated a fair agreement between the two models and suggested the usage of FGRS for proactive management of cardiovascular disease risk. Additionally, the employees presented a high cardiovascular disease risk with more novel risk factors and traditional risk factors than the remaining groups. Moreover, a culturally based strategy, evidence-based preventative program, workplace, and community policies would be advised to establish a safe world of work in the industrial environment and for the community at large. Hence, a reduction of CVDs direct and indirect costs and improvement of quality of health and production.