Cardiovascular risk factor awareness in a disadvantaged inner-city population—implications for preventive strategies

Background — Disadvantaged inner-city populations have significantly higher cardiovascular disease (CVD) mortality rates than the general population. Whether a deficiency in the level of awareness, a prerequisite for change, exists that contributes to this socioeconomic divide has not been well established.

Objectives — To address CVD risk by assessing the knowledge of CVD risk factors of an inner-city population and comparing it with that of the general population by establishing determinants of CVD knowledge and identifying potential barriers to CVD risk factor reduction in the inner city.

Methods — Cross-sectional survey of 136 consecutive patients 40 years of age and older attending an inner-city community health centre. The comparison group consisted of 807 age-matched respondents from the Canadian Heart Health Study, a random sample survey of the general adult Canadian population. Outcome measures included CVD risk factor knowledge, CVD risk factor prevalence and barriers to reducing CVD risk.

Results — There was no significant difference between inner-city respondent ability to name five of the seven CVD risk factors compared with the general population. Two CVD risk factors were more readily recalled by the inner-city group (lack of exercise, P<0.001; heredity, P=0.003). The average number of risk factors named by an individual from the inner city was significantly higher than the general population (3.1 versus 2.6; P<0.001). Among the inner-city respondents, socioeconomic factors, including higher education level (OR 5.224; P<0.001) and being married (OR 3.651; P=0.008), were independently related to good CVD knowledge; high CVD risk was not related. Lack of motivation (57%), lack of time (34%) and lack of money (30%) were commonly reported as barriers to addressing CVD risk.

Conclusions — Elevated CVD risk in the inner city may not be attributable to a deficiency in the level of awareness. However, the relationship between socioeconomic status and knowledge is maintained within the lowest social class tier. The identification of barriers linked to inner-city life has implications for prevention of CVD in the inner city; results suggest that interventions that combine health education with motivational approaches, while necessary, may not be sufficient.