Project 2: Cardiometabolic Disease and Risk Factors Among Older Adults in Sub-Saharan Africa Cardiovascular disease (CVD) has become the leading cause of death globally as a result of epidemiologic, social, and economic transitions globally. These transitions are at a relatively early stage in Sub-Saharan Africa (SSA), with the countries under study at different stages and experiencing contrasting trajectories. The purpose of this project is to establish cohorts of persons aged 50 and over in rural South Africa, Ghana, and Tanzania and, in doing so, characterize the changing rates, causes, and consequences of cardiometabolic disorders among older people in African settings undergoing demographic transition. Reliable data on baseline levels of chronic cardiometabolic disease (CMD) such as CVD and diabetes in older ages are extremely limited in rural SSA but understanding the rate of change in CMD is critical for social and health policy planning. Effective follow-up of participants and collection of self-reported health status and clinic and hospital services as well as established biomarkers and verbal autopsies will lead to a comprehensive understanding of the complex biologic, behavioral, demographic, and socioeconomic factors causing increasing death and associated risk from cardiovascular and metabolic disorders. Our long term goal is to enrich the INDEPTH cohort studies systems in Ghana,.South Africa and Tanzania so they can be used to plan health and social services to identify high risk individuals who can benefit from simple interventions to reduce CMD morbidity and mortality. Our overall project objective is to establish a baseline of key traditional and novel CMD risk factors, assess trajectories of select risk factors, and test whether easily identified and modifiable risk factors predict future mortality in African populations 50 and over in diverse settings where infectious disease including HIV/AIDS is prominent.
The specific aims of Project 2 are: 1. To compare baseline prevalence of risk factors and advanced CMD across 3 SSA communifies 2. To establish trajectories and patterns of change in traditional and novel CMD risk factors and established CVD 3. To develop models to assess the association between traditional and novel biologic risk factors, social and environmental risk factors, and CVD mortality in areas of differential HIV prevalence.

Public Health Relevance

This project provides a unique opportunity to generate much-needed comparative data and understanding on this largely overlooked community and will be a major advance in the depth of evidence available to inform health systems development, including health promotion, and social policy towards the care and support of older adults in Sub-Saharan countries undergoing complex epidemiological and demographic transitions. Finally, development of a simple screening tool for cardiometabolic disease that is made up of easily obtainable non-lab based risk markers and combines biological, social, economic and environmental factors offers a novel and cost-saving approach for identifying cardiometabolic risk.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Program Projects (P01)
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Special Emphasis Panel (ZAG1-ZIJ-1)
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Harvard University
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Harling, Guy; Morris, Katherine Ann; Manderson, Lenore et al. (2018) Age and Gender Differences in Social Network Composition and Social Support Among Older Rural South Africans: Findings From the HAALSI Study. J Gerontol B Psychol Sci Soc Sci :
Chetty, Terusha; Yapa, H Manisha N; Herbst, Carina et al. (2018) The MONARCH intervention to enhance the quality of antenatal and postnatal primary health services in rural South Africa: protocol for a stepped-wedge cluster-randomised controlled trial. BMC Health Serv Res 18:625
Gómez-Olivé, F Xavier; Montana, Livia; Wagner, Ryan G et al. (2018) Cohort Profile: Health and Ageing in Africa: a Longitudinal Study of an INDEPTH Community in South Africa (HAALSI). Int J Epidemiol :
Yapa, H Manisha; Bärnighausen, Till (2018) Implementation science in resource-poor countries and communities. Implement Sci 13:154
Harling, Guy; Gumede, Dumile; Shahmanesh, Maryam et al. (2018) Sources of social support and sexual behaviour advice for young adults in rural South Africa. BMJ Glob Health 3:e000955
Geldsetzer, Pascal; Fink, Günther; Vaikath, Maria et al. (2018) Sampling for Patient Exit Interviews: Assessment of Methods Using Mathematical Derivation and Computer Simulations. Health Serv Res 53:256-272
Gómez-Olivé, F Xavier; Rohr, Julia K; Roden, Laura C et al. (2018) Associations between sleep parameters, non-communicable diseases, HIV status and medications in older, rural South Africans. Sci Rep 8:17321
Kobayashi, Lindsay C; Berkman, Lisa F; Wagner, Ryan G et al. (2018) Education modifies the relationship between height and cognitive function in a cross-sectional population-based study of older adults in Rural South Africa. Eur J Epidemiol :
Payne, Collin F; Davies, Justine I; Gomez-Olive, F Xavier et al. (2018) Cross-sectional relationship between haemoglobin concentration and measures of physical and cognitive function in an older rural South African population. J Epidemiol Community Health 72:796-802
Hontelez, Jan A C; Bor, Jacob; Tanser, Frank C et al. (2018) HIV Treatment Substantially Decreases Hospitalization Rates: Evidence From Rural South Africa. Health Aff (Millwood) 37:997-1004

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