Cardiovascular sex differences and associated factors among adult population in Somaliland using insights from Somaliland demography and health survey.

Study objective: To examine sex differences and identify associated risk factors for cardiovascular disease (CVD) among adults in Somaliland, in order to inform targeted public health interventions. Design: A cross-sectional analysis of nationally representative survey data. Setting: Community-based, covering all regions of Somaliland. Participants: A sample of 20,669 adults from the 2020 Somaliland Demographic and Health Survey (SLDHS). Interventions: Not applicable (observational study). Main outcome measures: The primary outcome was the prevalence of self-reported, doctor-diagnosed CVD (including coronary heart disease, hypertensive heart disease, and stroke). Key determinants were assessed via adjusted odds ratios (AOR) from multivariable logistic regression. Results: The overall CVD prevalence was 0.94%, with significant sex and geographic disparities. Hypertension was the strongest predictor overall (AOR = 4.68, 95% CI: 3.26-6.71), with a greater effect in females (AOR = 5.10, 95% CI: 3.23-8.04). Diabetes was a significant risk factor for males only (AOR = 2.59, 95% CI: 1.11-6.07). Widowhood and rural residence increased CVD risk for females, while nomadic residence was protective for males. Conclusions: This study reveals significant, sex-specific disparities in CVD determinants in Somaliland. Public health strategies must prioritize hypertension and diabetes control, improve healthcare access for women-particularly widowed and rural residents-and develop regionally tailored interventions to mitigate the growing CVD burden.