Prevalence, Determinants, and Time Trends of Cardiovascular Health in the WHO African Region.

Importance: The distribution and determinants of cardiovascular health (CVH) in the World Health Organization (WHO) African Region have been limited to single-country studies. Objective: To estimate the distribution and determinants of CVH score in the WHO African Region, which comprises Algeria and countries in Sub-Saharan Africa. The secondary objective was to estimate time trends in CVH over 20 years. Design, Setting, and Participants: This study constituted repeated nationwide and subnational cross-sectional WHO STEPS (STEPwise Approach to Noncommunicable Disease Risk Factor Surveillance) surveys from 2003 to 2022 in 22 countries in the WHO African Region. Participants included nonpregnant adults aged 18 to 69 years without known cardiovascular disease (CVD). Exposures: Individual factors (age, sex, education level, and marital status) and contextual data from the United Nations Development Programme and the World Bank databases. Main Outcomes and Measures: The primary outcome was the weighted prevalence of the Life's Simple 7 score categories (0-7, 8-11, and 12-14 indicating poor, intermediate, and ideal CVH, respectively) and the factors associated with CVH status. Results: The study population included 73 024 individuals free of CVD (mean [SD] age, 35.4 [12.9] years; 49 505 female [weighted, 49.4%]) and representing 95 million people across 22 countries and 25 surveys. The weighted prevalence of ideal, intermediate, and poor CVH was 26.2% (95% CI, 25.7%-28.0%), 57.9% (95% CI, 54.8%-59.0%), and 15.9% (95% CI, 15.1%-17.0%), respectively. Older age, female sex, lower education, and heavy alcohol consumption were associated with lower odds of achieving intermediate or ideal CVH scores (females vs males: odds ratio [OR] for intermediate CVH, 0.77; 95% CI, 0.67-0.89; OR for ideal CVH, 0.80; 95% CI, 0.64-0.92; ages 55-69 vs 18-25 years: OR for intermediate CVH, 0.14; 95% CI, 0.10-0.20; OR for ideal CVH, 0.06; 95% CI, 0.04-0.09; no education vs tertiary: OR for ideal CVH, 0.63; 95% CI, 0.43-0.92; heavy episodic drinking vs nondrinking: OR for ideal CVH, 0.51; 95% CI, 0.39-0.67). Country-level contextual factors, particularly higher mean years of schooling (β = 0.24; 95% CI, 0.17-0.32), higher education percentage (β = 0.01; 95% CI, 0-0.02), and higher prevalence of undernourishment (β = 3.14; 95% CI, 0.63-5.65), were associated with higher CVH scores. The spatial-temporal model did not reveal any statistically significant trend in the weighted prevalence of CVH score categories between 2003 and 2022, overall and by sex. Conclusions and Relevance: This situational analysis of cross-sectional WHO STEPS surveys of CVH status region identified actionable factors of the CVH status across 22 countries in the WHO African Region. This information is crucial for guiding policy efforts in CVD prevention in countries of the WHO African Region.