Geographic and Demographic Variation in the Prevalence of the Metabolic Syndrome in Canada

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Geographic and Demographic Variation in the
Prevalence of the Metabolic Syndrome in Canada
Chris Ardern School of Physical and Health
Education Queens University, Kingston, ON
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Metabolic Syndrome and Mortality

1209 Finnish Men, 40-62 years old 11.4 years of
Follow-up
CHD
CVD
All-cause
Lakka et al. JAMA. 20022882709-16.
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Ardern et al. Obes Res. 200311(1)135-42.
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Overall MetS 25.8 N1276 (35-75 y)
45.4
41.3
28.8
28.3
23.4
15.9
14.3
7.1

• Anand SS et al. Circ 2003108(4)420-5

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• Social and Geographic Gradients in
  Cardiovascular Risk Factors (CHHS)
• Variation in overweight and obesity (Reeder,
  1997)
• CVD risk factor knowledge (MacDonald, 1997
  Stachenko, 1992)
• CVD risk factor clustering (MacDonald, 1997)

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Objectives

• 1. Describe the demographic (SES) and geographic
  (provincial) variation in the prevalence of the
  metabolic syndrome.
• Explore the relationship between SES and
  metabolic syndrome within broad geographical
  regions (Atlantic, Central, and Western Canada).

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Methods

• Data Collection (clinic and home visit)
• Anthropometry
• Blood chemistry analyses
• Blood pressure
• Demographic, heart health history, and health
  habits/nutrition questionnaire

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NCEP Metabolic Syndrome

• 3 or more of the following
• Abdominal Obesity (M WCgt102 cm F WCgt88 cm)
• Low HDL-C (M lt1.04 mM F lt1.29 mM)
• High TG (?1.69 mM)
• High BP (?130/85 mmHg)
• High BG (?6.1 mM now 5.6 mM)

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Adaptations to NCEP Definition
MetS Using WC 16.2 MetS Using BMI 15.9
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170 cases of MetS5.7
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• Results
• Geographic Variation

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Men
Women
Atlantic Central Western
Atlantic Central Western
plt0.05 using ?2 for proportions by sex, across
demographic regions Rural/urban analysis in
Atlantic region does not include NS percentage
above thresholds for the individual component of
the metabolic syndrome definition (see methods
section) a p0.01
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Age-Adjusted Prevalence of MetS
Women 13.2
Men 18.2
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Men
Atlantic 21.5 Rural 22.4 Urban 20.0
Western 16.3 Rural 19.8 Urban 15.0
Central 19.3 Rural 19.6 Urban 19.2
Atlantic (PEI, NF, NB N2 537) Central (ON, QC
N1 628) Western (MB, SK, AB, BC N3 337)
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Women
Western 13.8 Rural 18.7 Urban 12.2
Atlantic 19.8 Rural 21.2 Urban 18.1
Central 14.3 Rural 12.6 Urban 12.6
Atlantic (PEI, NF, NB N2 632) Central (ON, QC
N1 590) Western (MB, SK, AB, BC N3 319)
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• Results
• Demographic Variation

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Income Adequacy
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Educational Attainment
? Elementary school Some
secondary schooling Secondary school completed
University degree completed
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Risk Factor Knowledge
plt0.05 between normal and metabolic syndrome
within geographical region percentage above
threshold for the individual component of the
metabolic syndrome (see methods section)
Question text What do you think are the major
causes of heart disease or heart problems?
Esuppressed estimate due to cell count lt30
observations
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• Results
• Multivariate Analysis

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Bold indicates plt0.05
Men
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Bold indicates plt0.05
Women
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Nova Scotia was excluded from the Atlantic region
for this analysis as no information on
rural/urban status was available. Bold indicates
plt0.05 compared to referent group. Adjusted for
age, cigarette smoking, sedentary leisure time,
occupational physical activity, previous heart
attack or stroke, and low cardiovascular risk
factor knowledge.
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• Clinical Relevance

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• MetS is useful for surveillance of CVD risk
  factor clustering
• Caveats
• Use of self-reported diabetes instead of fasting
  blood glucose means that the prevalence of MetS
  in this study is underestimated.
• 2. Lack of information on ethnicity in CHHS may
  result in misclassification of MetS across
  provinces.
• 3. CHHS was collected between 1986-1992.

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Conclusions

1. The distribution of the metabolic syndrome in
   Canada is regionally diverse.
2. The impact of educational attainment on risk of
   the metabolic syndrome may vary by sex and
   geographical region.
3. Identification of high-risk SES groups may assist
   in the delivery of patient-centered primary risk
   factor screening.

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The Canadian Heart Health Surveys Follow-up Study
is a New Emerging Team, funded by the Canadian
Institutes for Health Research and the Heart and
Stroke Foundation of Canada
www.chhsnet.ca