Abstract
Objectives
Cardiovascular disease (CVD) is the leading cause of death in China. This study compared ethnic disparities and lifestyle determinants in the prevalence of CVD (hypertension, coronary heart disease [CHD], and stroke) among older adults of the Han majority and Ha Ni ethnic minority in rural southwest China, to provide evidence for preventing and controlling CVD among older-adult minority communities.
Methods
A multi-stage stratified random sampling method was used to select 1,413 Han majority participants and 1,402 Ha Ni ethnic minority participants aged ≥ 60 years in rural Southwest China. Data on general demographic characteristics, behavioral lifestyle, and self-reported diagnostic information for patients with CHD and stroke were collected using a standardized questionnaire. The height, weight, waist circumference, and blood pressure of each participant were recorded. The relationship between lifestyle factors and CVD was analyzed using multivariate logistic regression.
Results
Han majority older adults had a higher prevalence of CHD (6.4% vs. 3.6%) and stroke (7.9% vs. 2.9%) than their Ha Ni minority counterparts (P < 0.01). Han majority participants had a markedly higher prevalence of obesity, central obesity, and physical inactivity than their Ha Ni ethnic minority counterparts (9.2%, 48.3%, and 55.1% vs. 3.4%, 19.1%, and 49.2%, respectively, P < 0.01). By contrast, Ha Ni ethnic minority participants had a higher prevalence of current drinking than Han majority participants (31.2% vs. 14.4%, P < 0.01). Among Han majority and Ha Ni ethnic minority older adults, participants with central obesity (OR = 2.09, 95% CI: 1.62–2.69 vs. OR = 2.66, 95% CI: 1.88–3.76) had a higher risk of hypertension, participants with obesity (OR = 1.99, 95% CI: 1.02–3.67 vs. OR = 3.66, 95% CI: 1.39–9.66) were more likely to suffer from CHD, and participants with physical inactivity (OR = 1.88, 95% CI: 1.18–2.98 vs. OR = 2.29, 95% CI: 1.13–4.64) had a higher probability of suffering from stroke. Furthermore, Current drinking status increased the risk of CHD (OR = 2.31, 95% CI: 1.05–5.08), but decreased the risk of stroke (OR = 0.33, 95% CI: 0.13–0.83) in Ha Ni ethnic minority participants.
Conclusion
CHD and stroke are more prevalent among the Han majority older adults in rural Southwest China, and lifestyle factors significantly influence CVD.
Keywords: Han majority, Ha Ni ethnic minority, Cardiovascular disease, Ethnic disparities, China
Introduction
Cardiovascular disease (CVD) is the leading cause of death and disability globally [1]. The number of deaths from CVD continues to increase, with approximately 18.6 million deaths reported worldwide in 2019, and at least three-quarters of CVD deaths occurring in low- and middle-income countries [1, 2]. China has the highest number of CVD deaths [3], with the number increasing from 3.09 million in 2005 to 4.58 million in 2020. CVD ranks first in terms of mortality rate among urban and rural residents, surpassing cancer and other diseases [4]. Rural areas in China have higher CVD mortality rates than urban areas, and this gap is gradually widening [5, 6]. Recent data show that approximately 330 million people in China currently suffer from CVD, with hypertension, coronary heart disease (CHD), and stroke being the most prevalent [4].
Population aging is a significant factor exacerbating the CVD burden [3]. China has the largest older-adult population in the world [7]; in 2020, 18.70% of China’s population was ≥ 60 years (264 million), and the share of the population aged > 60 years increased by 5.44% (from 13.26% in 2010 to 18.70% in 2020) in the past 10 years [8]. The prevalence of CVD increases with age, placing older adults at higher risk for hypertension [9], CHD [10], and stroke [11]. Studies have indicated that rural areas in China face a higher burden of CVD and have fewer health services resources [12]. Therefore, rural areas face more serious health challenges owing to widening urban–rural disparities in the distribution of CVD burdens and health resources.
China is a multi-ethnic country with 56 ethnic groups. The Han ethnic group constitutes the majority of the population, whereas the remaining 55 groups are considered ethnic minorities. There are clear differences between ethnic minorities and the Han majority in terms of culture, customs, and religious beliefs. Many previous studies have shown that there are significant differences in the prevalence of CVD among different ethnic groups [13, 14]. Ethnic minorities experience disparities in economic income, education level, and medical services compared with the Han majority, and socioeconomic status is strongly associated with the burden of CVD [15, 16]. Additionally, lifestyle factors can affect the risk and mortality associated with CVD [17, 18].
Yunnan Province, situated on the southwestern border of China, is home to the largest number of ethnic minorities in the country. It is home to 25 ethnic minorities, 15 of whom reside exclusively in the province. Among these 15 unique ethnic groups, the Ha Ni ethnic group is the most populous. A better understanding of disparities in CVD prevalence and lifestyle factors among diverse ethnic groups is crucial for developing future CVD prevention and treatment strategies. Currently, few studies have compared the Ha Ni ethnic minority and Han majority. Therefore, this study aimed to investigate the differences in CVD prevalence and lifestyle factors between older adults from these ethnic groups in rural Southwest China. The findings of this study provide valuable information for future related studies and serve as a theoretical reference for the prevention and treatment of CVD in ethnic minority areas.
Methods
Study area and population
A community-based cross-sectional survey was conducted in the rural areas of Mojiang Ha Ni Autonomous County, Yunnan Province. Data were collected using questionnaire health surveys and physical examinations in 2021. Mojiang County has a resident population of 276,600, of which 66.22% belong to the Ha Ni ethnic minority, making it the only Ha Ni autonomous county in China. Study participants were selected using a multistage stratified random sampling method. The 15 townships/towns in Mojiang County were divided into two groups based on per capita gross national product (GDP): good and poor. One township/town was randomly selected from each stratum. Subsequently, using the probability proportional to size method, three Han-dominated and three Ha Ni-dominated sample villages were selected from each of the two townships/towns. Finally, using the simple random sampling method, Han and Ha Ni residents aged ≥ 60 years who had lived in the sample villages for ≥ 5 years were selected as the study participants.
Data collection and measure
Highly trained investigators conducted face-to-face interviews with respondents using a structured questionnaire. General demographic characteristics, behavioral lifestyle information, and self-reported diagnostic information of patients with CHD and stroke were obtained. Physical examinations included height, weight, waist circumference, and blood pressure (BP).
According to the recommendations of the American Heart Association, BP was measured using a standard mercury sphygmomanometer and the mean of three measurements was recorded [19].
Definitions
Hypertension was defined as a mean systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, or a normal blood pressure value but currently under antihypertensive medication treatment [20]. CHD and stroke were derived from respondents’ self-reports based on previous physician diagnoses.
Body mass index ≥ 28 was considered obese. According to the World Health Organization’s recommendations for Asian adults, waist circumference ≥ 90 cm for men and ≥ 85 cm for women was defined as central obesity.
Current smokers were defined as participants who smoked all forms of tobacco products daily. Current drinkers were defined as those who drank alcohol regularly, one or more times per week, in the past year. Physical inactivity was defined as failure to achieve 150 min/week of cumulative moderate-intensity or 75 min/week of vigorous-intensity aerobic physical activity [21]. Illiteracy was defined as the inability to comprehend, read, and write a complete sentence. Approximate Annual household income was divided into low (< 6000CNY) and high (≥ 6000CNY), with the median value as the cut-off point. Medical service accessibility was categorized as poor (≥ 30 min) and good (< 30 min) based on the time taken to walk to the nearest healthcare facility from the respondent’s place of residence.
Statistical analysis
Data analysis was conducted using SPSS version 26.0, and categorical data were expressed as counts and percentages. The chi-square test was used to compare the same categorical variables between Han majority and Ha Ni ethnic minority participants. Logistic regression was used to analyze the association of the hypertension, CHD, and stroke with lifestyle factors. Model 1 was a crude model without any adjustment. To ensure the reliability of the results, Model 2 controlled for confounders such as sex, age, educational level, annual household income, and medical service accessibility. Associations were expressed as odds ratios. The prevalence of hypertension, CHD, and stroke was adjusted for age and sex by direct standardization through the total population surveyed in both ethnic groups. P values < 0.05 was considered statistically significant.
Result
Among both ethnic groups, 1,450 individuals aged ≥ 60 years were invited to participate in this survey, of whom 1,413 Han majority and 1,402 Ha Ni ethnic minority older adults agreed to participate, with response rates of 97.4% and 96.7%, respectively.
Table 1 presents the respondents’ demographic characteristics by gender. The education level, annual income, and medical service accessibility of the Han majority participants were better than those of their Ha Ni ethnic minority counterparts (P < 0.05). Additionally, Han majority participants exhibited a higher prevalence of obesity, central obesity, and physical inactivity than Ha Ni ethnic minority participants, while the proportion of current drinkers was lower than that of the Ha Ni ethnic minority group (all P < 0.05).
Table 1.
Demographic and lifestyle characteristics of the study population
| Characteristic | Han majority | Ha Ni ethnic minority | |||||
|---|---|---|---|---|---|---|---|
| Male(n = 686) | Female(n = 727) | All(n = 1413) | Male(n = 673) | Female(n = 729) | All(n = 1402) | ||
| Age groups (%) | |||||||
| 60–64 | 113(16.5) | 114(15.7) | 227(16.1) | 212(31.5) | 197(27.0) | 409(29.2) | |
| 64–69 | 227(33.1) | 238(32.7) | 465(32.9) | 226(33.6) | 194(26.6) | 420(30.0) | |
| 70–74 | 178(25.9) | 189(26.0) | 367(26.0) | 126(18.7) | 169(23.2) | 295(21.0) | |
| ≥ 75 | 168(24.5) | 186(25.6) | 354(25.1) | 109(16.2)b | 169(23.2)bd | 278(19.8)b | |
| Educational level (%) | |||||||
| Illiterate | 174(25.4) | 384(52.8) | 558(39.3) | 225(33.4) | 639(87.7) | 864(61.6) | |
| Primary (1–6 grade) or higher | 512(74.6) | 343(47.2) d | 855(60.5) | 448(66.6)b | 90(12.3)bd | 538(38.4)b | |
| Approximate annual household income (%) | |||||||
| Low | 354(51.6) | 388(53.4) | 742(52.5) | 402(59.7) | 424(58.2) | 826(58.9) | |
| High | 332(48.4) | 339(46.6) | 671(47.5) | 271(40.3)b | 305(41.8) | 576(41.1)b | |
| Access to medical service (%) | |||||||
| Poor | 305(44.5) | 299(41.1) | 604(42.7) | 397(59.0) | 414(56.8) | 811(57.8) | |
| Good | 381(55.5) | 428(58.9) | 809(57.3) | 276(41.0)b | 315(43.2)b | 591(42.2)b | |
| Obesity (%) | 49(7.1) | 81(11.1)c | 130(9.2) | 20(3.0)b | 28(3.8)b | 48(3.4)b | |
| Central obesity (%) | 238(34.7) | 444(61.1)d | 682(48.3) | 93(13.8)b | 175(24.0)bd | 268(19.1)b | |
| Current smokers (%) | 290(42.3) | 5(0.7)d | 295(20.9) | 330(49.0)a | 4(0.5)d | 334(23.8) | |
| Current drinkers (%) | 182(26.5) | 22(3.0)d | 204(14.4) | 392(58.2)b | 46(6.3)bd | 438(31.2)b | |
| Physical inactivity (%) | 363(52.9) | 415(57.1) | 778(55.1) | 304(45.2)b | 386(52.9)d | 690(49.2)b | |
ap < 0.05, bp < 0.01, comparisons among different ethnic populations; cp < 0.05, dp < 0.01, comparisons between different sexes
Table 2 shows the distribution of the age-standardized prevalence of the three CVDs (hypertension, CHD, and stroke) among both groups according to general demographic characteristics and lifestyle. The prevalence of hypertension was 64.5% in the Han majority and 63.4% in the Ha Ni ethnic minority, with no significant difference (P > 0.05). However, the prevalence of hypertension increased with age in both ethnicities. The prevalence of CHD and stroke among Han majority participants (6.4% and 7.9%, respectively) was significantly higher than that among Ha Ni ethnic minority participants (3.6% and 2.9%, respectively), with differences also observed in subgroups stratified by age, sex, education, annual household income, and medical service accessibility (P < 0.05). The prevalence of hypertension and stroke among both groups of older adults who had obesity, central obesity, and physical inactivity was higher than that of their peers, and Ha Ni ethnic minority individuals with obesity and central obesity had a higher prevalence of CHD (P < 0.05).
Table 2.
Prevalence of CVD between Han majority and Ha Ni ethnic minority elderly people of Yunnan Province, China
| Characteristic | Han majority | Ha Ni ethnic minority | |||||
|---|---|---|---|---|---|---|---|
| Hypertension, n (%) | CHD, n (%) |
Stroke , n (%) |
Hypertension, n (%) | CHD, n (%) |
Stroke, n (%) |
||
| Gender | |||||||
| Male | 421(61.4) | 39(5.7) | 55(8.0) | 444(66.0) | 20(3.0)a | 25(3.7)b | |
| Female | 490(67.4)c | 51(7.0) | 56(7.7) | 445(61.0)a | 31(4.3)a | 16(2.2)b | |
| Age groups (%) | |||||||
| 60–64 | 136(59.9) | 11(4.8) | 18(7.9) | 230(56.2) | 14(3.4) | 10(2.4)b | |
| 64–69 | 280(60.2) | 35(7.5) | 26(5.6) | 259(61.7) | 13(3.1)b | 13(3.1) | |
| 70–74 | 243(66.2) | 21(5.7) | 33(9.0) | 206(69.8) | 16(5.4) | 10(3.4)b | |
| ≥ 75 | 252(71.2)d | 23(6.5) | 34(9.6) | 194(69.8)d | 8(2.9)a | 8(2.9)b | |
| Education Level (%) | |||||||
| Illiterate(%) | 351(62.9) | 33(5.9) | 33(5.9) | 544(63.0) | 33(3.8) | 22(2.5)b | |
| Primary (1–6 grade) or higher | 560(65.5) | 57(6.7) | 78(9.1)c | 345(64.1) | 18(3.3)b | 19(3.5)b | |
| Approximate annual household income (%) | |||||||
| Low | 448(60.4) | 44(5.9) | 45(6.1) | 523(63.3) | 37(4.5) | 28(3.4)a | |
| High | 463(69.0)d | 46(6.9) | 66(9.8) | 366(63.5)a | 14(2.4)b | 13(2.3)b | |
| Access to medical service (%) | |||||||
| Poor | 337(55.8) | 35(5.8) | 41(6.8) | 517(63.7)b | 30(3.7) | 23(2.8)b | |
| Good | 574(71.0)d | 55(6.8) | 70(8.7) | 372(62.9)b | 21(3.6)b | 18(3.0)b | |
| Obesity (%) | |||||||
| Yes | 114(87.7) | 15(11.5) | 17(13.1) | 852(62.9) | 8(16.7) | 6(12.5) | |
| No | 797(62.1)d | 75(5.8)c | 94(7.3)c | 37(77.1)c | 43(3.2)bd | 35(2.6)bd | |
| Central obesity (%) | |||||||
| Yes | 517(75.8) | 50(7.3) | 69(10.1) | 679(59.9) | 21(7.8) | 18(6.7) | |
| No | 394(53.9)d | 40(5.5) | 42(5.7)d | 210(78.4)ad | 30(2.6)bd | 23(2.0)bd | |
| Current smokers (%) | |||||||
| Yes | 176(59.7) | 13(4.4) | 18(6.1) | 221(66.2) | 8(2.4) | 8(2.4)a | |
| No | 735(65.7) | 77(6.9) | 93(8.3) | 668(62.5) | 43(4.0)b | 33(3.1)b | |
| Current drinkers (%) | |||||||
| Yes | 131(64.2) | 8(3.9) | 9(4.4) | 288(65.8) | 17(3.9) | 7(1.6)a | |
| No | 780(64.5) | 82(6.8) | 102(8.4)c | 601(62.3) | 34(3.5)b | 34(3.5)b | |
| Physical inactivity (%) | |||||||
| Yes | 546(70.2) | 53(6.8) | 81(10.4) | 459(66.5) | 29(4.2)a | 27(3.9)b | |
| No | 365(57.5)d | 37(5.8) | 30(4.7)d | 430(60.4)c | 22(3.1)a | 14(2.0)bc | |
| All | 911(64.5) | 90(6.4) | 111(7.9) | 889(63.4) | 51(3.6)b | 41(2.9)b | |
ap < 0.05, bp < 0.01, comparisons among different ethnic populations; cp < 0.05, dp < 0.01, comparison between different groups of the same ethnic
Table 3 presents the results of a multivariate logistic regression analysis for prevalence of hypertension, CHD, and stroke according to lifestyle factors. Obesity (OR = 2.82, 95% CI: 1.61–4.95), central obesity (OR = 2.09, 95% CI: 1.62–2.69), and physical inactivity (OR = 1.32, 95% CI: 1.04–1.68) were positively associated with the prevalence of hypertension in Han majority participants, while central obesity (OR = 2.66, 95% CI: 1.88–3.76) was positively associated with the prevalence of hypertension in Ha Ni ethnic minority participants. Han majority participants with obesity (OR = 1.99, 95% CI: 1.02–3.67) exhibited a higher risk of CHD. Ha Ni ethnic minority participants with obesity (OR = 3.66, 95% CI: 1.39–9.66), central obesity (OR = 2.11, 95% CI: 1.07–4.16) and current drinking status (OR = 2.31, 95% CI: 1.05–5.08) exhibited a higher risk of CHD. Among Han majority participants, physical inactivity (OR = 1.88, 95% CI: 1.18–2.98) was associated with an increased risk of stroke. Among Ha Ni ethnic minority participants, central obesity (OR = 2.98, 95% CI: 1.43–6.19) and physical inactivity (OR = 2.29, 95% CI: 1.13–4.64) were positively associated with stroke prevalence, whereas current drinking status (OR = 0.33, 95% CI: 1.13–4.64) was associated with a lower risk of stroke.
Table 3.
Logistic regression of CVD prevalence by lifestyle factors among Han majority and Ha Ni ethnic minority elderly people of Yunnan Province, China
| Hypertension | CHD | Stroke | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Han majority | Ha Ni ethnic minority | Han majority | Ha Ni ethnic minority | Han majority | Ha Ni ethnic minority | ||||||
| OR (95%CI) | OR (95%CI) | OR (95%CI) | OR (95%CI) | OR (95%CI) | OR (95%CI) | ||||||
| Model 1 | |||||||||||
| Obesity(reference: no) | 2.64**(1.51–4.60) | 1.03(0.49–2.16) | 1.93*(1.03–3.64) | 3.65**(1.41–9.42) | 1.40(0.78–2.52) | 2.79(0.98–7.94) | |||||
| Central obesity(reference: no) | 2.23**(1.75–2.84) | 2.55**(1.81–3.59) | 1.09(0.68–1.75) | 2.27*(1.16–4.44) | 1.50(0.97–2.30) | 2.70**(1.31–5.55) | |||||
| Current smoker(reference: no) | 0.85(0.63–1.13) | 1.19(0.88–1.62) | 0.72(0.38–1.35) | 0.52(0.22–1.24) | 0.89(0.51–1.54) | 1.42(0.57–3.51) | |||||
| Current drinker(reference: no) | 1.33(0.95–1.87) | 1.20(0.90–1.59) | 0.66(0.31–1.44) | 1.80(0.91–3.56) | 0.63(0.30–1.32) | 0.49(0.19–1.26) | |||||
| Physical inactivity(reference: no) | 1.57**(1.25–1.97) | 1.36**(1.09–1.70) | 1.08(0.70–1.68) | 1.58(0.88–2.83) | 2.11**(1.36–3.27) | 2.08*(1.07–4.07) | |||||
| Model 2 | |||||||||||
| Obesity(reference: no) | 2.82**(1.61–4.95) | 1.07(0.51–2.26) | 1.99*(1.02–3.67) | 3.66**(1.39–9.66) | 1.34(0.74–2.43) | 2.30(0.78–6.81) | |||||
| Central obesity(reference: no) | 2.09**(1.62–2.69) | 2.66**(1.88–3.76) | 1.07(0.65–1.74) | 2.11*(1.07–4.16) | 1.56(1.00-2.45) | 2.98**(1.43–6.19) | |||||
| Current smoker(reference: no) | 0.82(0.59–1.14) | 1.09(0.78–1.53) | 0.71(0.35–1.42) | 0.62(0.24–1.57) | 0.66(0.36–1.20) | 0.77(0.31–1.93) | |||||
| Current drinker(reference: no) | 1.41(0.99–2.01) | 1.07(0.79–1.46) | 0.64(0.29–1.42) | 2.31*(1.05–5.08) | 0.59(0.28–1.24) | 0.33*(0.13–0.83) | |||||
| Physical inactivity(reference: no) | 1.32*(1.04–1.68) | 1.21(0.95–1.53) | 1.04(0.65–1.65) | 1.70(0.92–3.13) | 1.88**(1.18–2.98) | 2.29*(1.13–4.64) | |||||
*P < 0.05, **P < 0.01
OR: Odds ratio
Model 1: Unadjusted
Model 2: Adjusted for sex, age, educational level, approximate annual household income, access to medical service
Discussion
This study revealed significant ethnic disparities in the prevalence of CVD and lifestyle determinants among Han majority and Ha Ni ethnic minority older adults in rural Southwest China. The prevalence of CHD and stroke were significantly higher in the Han majority than in the Ha Ni ethnic minority, whereas the relationship between lifestyle factors and CVD prevalence varied by ethnicity.
The prevalence of hypertension among Han majority and Ha Ni ethnic minority participants (64.5% and 63.4%, respectively) was similar to that among older adults in Hebei Province (63.7%) [22]. However, it was lower than that observed in Malaysia (74.0%) [23] and higher than that in China (54.6%) [24] and Africa (55.2%) [25], as well as in previous studies in rural Yunnan (53.0%) [26]. Hypertension is prevalent in the older-adult population. Furthermore, the prevalence of hypertension increases with age, making older adults a crucial population for hypertension prevention and treatment research. Hypertension is an independent risk factor of CVD. Therefore, it is important to consider the potential benefits of controlling BP to prevent an emerging CVD epidemic in rural Southwest China.
The Han majority exhibited a higher prevalence of CHD and stroke (6.4% and 7.9%, respectively) than the Ha Ni ethnic minority (3.6% and 2.9%, respectively). This difference may be attributed to higher rates of obesity, central obesity, and physical inactivity among the Han majority participants. These factors are associated with an increased prevalence of CHD and stroke [27, 28]. Ethnic disparities in the risk of CHD and stroke have also been identified in Western countries, largely due to persistent disparities in socioeconomic status and health resource utilization [29–31]. In this study, we found that income, level of education, and access to medical services were lower among the Ha Ni ethnic minority than among the Han majority, potentially leading to an underestimation of the prevalence of CHD and stroke among Ha Ni ethnic minority older adults. This may partially explain the differences in the prevalence of CHD and stroke between the two ethnic groups. The findings of this study highlight an urgent need to invest more in health resources in the rural areas of China, increase health literacy, and improve access to health services for older adults in ethnic minority communities.
The present study also found that obesity and central obesity were positively associated with the probability of CHD and hypertension in the Han majority and Ha Ni ethnic minority, respectively. Obesity was positively associated with the prevalence of hypertension among Han majority participants, while central obesity was positively associated with the prevalence of CHD among Ha Ni ethnic minority participants. However, an association between central obesity and stroke has only been found in Ha Ni ethnic minority older adults. The significant roles of obesity and central obesity in the development of hypertension, CHD, and stroke are well established in the literature [32–35]. Therefore, controlling weight and reducing waist circumference in patients with obesity may provide an effective strategy for preventing CVD.
Prior research has indicated a correlation between smoking and an increased risk of developing CVD [36–38]. However, our findings did not support this association despite the higher prevalence of current smoking among both groups. The reason for this inconsistency remains unclear and requires further investigation. Notably, after adjusting for potential confounding factors, including sex, age, educational level, approximate annual household income, and access to medical services, we found that current drinkers exhibited a higher risk of CHD and a lower risk of stroke among Ha Ni ethnic minority older adults. A study conducted in the United States indicated that light and moderate alcohol intake may have protective effects against CVD-specific mortality [39]. However, increasing evidence indicates that even small amounts of alcohol can increase the risk of CVD, including stroke [40].
Among participants from both groups, those who were physically inactive were more likely to have experienced a stroke. Furthermore, Han majority older adults who were physically inactive were more likely to have hypertension. There is strong evidence that physical activity has beneficial effects on the prevention of metabolic disease and CVD [41]. Thus, regular and appropriate physical activity can reduce the prevalence of CVD.
Conclusion
This study showed that the prevalence of CHD and stroke was significantly higher among Han majority older adults in rural Southwest China than among the Ha Ni ethnic minority. Additionally, the findings revealed that ethnic and lifestyle factors significantly affect the prevalence of CVD. Therefore, our findings highlight the significance of ethnicity as a crucial factor in future CVD prevention and control efforts. Targeted behavioral interventions for different ethnic groups should be adopted to improve local CVD epidemics.
Limitation of this study
There are several limitations to the present study. First, the study utilized a cross-sectional design, which precludes the establishment of causal relationships. Second, the comparative analysis was limited to Han majority and Ha Ni ethnic minority populations, thus restricting the generalizability of the findings to other ethnic groups. Finally, the present study might underestimate the true prevalence of CHD and stroke as the results of CHD and stroke were derived from self-reports of the participants.
Acknowledgements
None.
Author contributions
LC conceptualized the research idea and revised the manuscript. YH carried out the study and drafted the manuscript. QL, MZ, GHL and LL collected the data. All authors have read and approved the final manuscript.
Funding
The data collection and analysis of this study was supported by grants from the National Natural Science Fund of China (grant numbers: 72064026), Major Union Specific Project Foundation of Yunnan Provincial Science and Technology Department and Kunming Medical University (202401AY070001-027). The funders had no role in the study design, decision to publish, or preparation of the manuscript.
Data availability
The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Declarations
Ethics approval and consent to participate
The Ethics Review Committee of Kunming Medical University approved the study, and all participants provided voluntary informed consent. The study was conducted in accordance with the Declaration of Helsinki.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.