title: Socioeconomic and demographic predictors of selected cardiovascular risk factors among adults living in Pohnpei, Federated States of Micronesia.
abstract: BACKGROUND
  The burden of cardiovascular disease (CVD) is increasing in low-to-middle income countries (LMIC). Although strong evidence for inverse associations between socioeconomic position and health outcomes in high-income countries exists, less is known about LMIC. Understanding country-level differences is critical to tailoring effective population health policy and interventions. We examined the association of socioeconomic position and demographic characteristics in determining CVD risk factors among adults living in Pohnpei, Federated States of Micronesia.
  
  
  METHODS
  We used data from the cross-sectional World Health Organization's STEPwise approach to surveillance 2002 Pohnpei dataset and logistic regression analyses to examine the association of socioeconomic position (education, income, employment) and demographics (age, sex) with selected behavioral and anthropometric CVD risk factors. The study sample consisted of 1638 adults (642 men, 996 women; 25-64 years).
  
  
  RESULTS
  In general, we found that higher education (≥13 years) was associated with lower odds for daily tobacco use (odds ratio [OR]: 0.46, confidence interval [CI]: 0.29-0.75, p = 0.004) and low physical activity (OR: 0.55, CI: 0.34-0.87, p = 0.027). Men had over three times the odds of daily tobacco use than women (OR: 3.18, CI: 2.29-4.43, p < 0.001). Among women, paid employment nearly doubled the odds of daily tobacco use (OR: 1.72, CI: 1.08-2.73, p = 0.006) than unemployment. For all participants, income > $10,000 was associated with over twice the odds of high blood pressure (BP) (OR: 2.24, CI: 1.43-3.51, p = 0.003), versus lower-income (<$5,000). Men had over twice the odds of high BP (OR: 2.01, CI: 1.43-2.83, p < 0.001) than women. Paid employment nearly doubled the odds of central obesity with the magnitude of association increasing by more than 20% adjusted for sex and age. Men reporting paid employment had three times the odds of central obesity (OR: 3.00, CI: 1.56-5.78, p < 0.001) than those unemployed.
  
  
  CONCLUSIONS
  Our analysis revealed associations between socioeconomic position and selected CVD risk factors, which varied by risk-factor, sex and age characteristics, and direction of association. The 2002 Pohnpei dataset provides country-level baseline information; further population health surveillance might define trends. Stronger country-level data might help decision-makers tailor population-based prevention strategies.
authors.affiliation: Division of Diabetes Translation, Centers for Disease Control and Prevention, National Center for Chronic Disease and Health Promotion, Mailstop K10, 2877 Brandywine Rd, Atlanta, GA 30341, USA. akapacific@hughes.net.
authors.forename: Gwendolyn M
authors.initials: GM
authors.lastname: Hosey
authors.forename: Marcus
authors.initials: M
authors.lastname: Samo
authors.forename: Edward W
authors.initials: EW
authors.lastname: Gregg
authors.forename: Diane
authors.initials: D
authors.lastname: Padden
authors.forename: Sandra Garmon
authors.initials: SG
authors.lastname: Bibb
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008849:Micronesia / Q000453:epidemiology; D008875:Middle Aged; D016017:Odds Ratio; D011159:Population Surveillance; D012307:Risk Factors; D012737:Sex Factors