Prevalence of modifiable cardiovascular risk factors among coffee estate workers in rural South India (CARE)

Authors : Sitarah Mathias, Akhil Xavier Joseph, Tanvi Jadhav, *Denis Xavier*

Publication Year : 2021

Abstract :

Cardiovascular (CV) disease is associated with high disability-adjusted life years and lifelong treatment expenditure. It disproportionately affects lower socioeconomic strata, who develop CV disease 10 years earlier, receive inferior treatment, and suffer higher short-term mortality than higher-income groups.[1] The labor-intensive coffee industry is an important component of the Indian export sector. Coffee's specific plantation requirements (shade, altitude, and moisture) often result in secluded plantations lacking adequate transport facilities. This leads to limited urban exposure, education (formal and informal), and access to health information and services. The resulting lack of awareness of diseases and the need for regular check-ups, follow-ups, and adherence to medication predisposes their employees to the consequences of unchecked CV risk factors. The further lack of access to health-care services– routine and emergency– compounds this issue leading to potentially higher rates of mortality and morbidity, especially among permanent workers, who reside on the estates all-year. Studies on tea plantation workers have demonstrated a high burden of CV risk factors,[2] yet, no data exist on coffee plantation workers. Furthermore, due to different employment environments and prevalent cultural norms, a direct extrapolation of results from tea workers to their coffee counterparts is implausible. This pilot study is aimed to assess the burden of CV risk factors among rural South Indian coffee workers.

After obtaining approval from the Institutional Ethical Committee (IEC no. 192/2015) and necessary authorizations by all estate owners, this cross-sectional study was conducted over 4 months, in 12 coffee estates across 4000 sq. km in rural South India. Informed consent was obtained from all workers ?30 years and with ?6 months of work experience, irrespective of their retirement status and permanent/migratory contract status. Six trained interviewers collected data on prior noncommunicable diseases (NCD) diagnoses (hypertension, diabetes, CV disease, strokes, Chronic lung and kidney disease and trauma resulting in permanent disability), treatment adherence (drug intake frequency >80%), and prevalence and awareness of risk factors (tobacco, alcohol, unhealthy diet, and physical activity), using an adapted WHO STEPS questionnaire.[2] Standardized implements and techniques were used to measure blood pressure (BP, mean of 2 readings), body mass index (BMI, mean of 2 readings), and waist: Hip circumference ratio (WHR). The WHO recommended sex-specific limits for Asians were used to determine raised waist circumference (80 cm for men, 90 cm for women) and raised WHR (0.85 for men, 0.90 for women). Framingham risk scores (FRS) were calculated, and the workers were classified as having either low (?10%) or intermediate-high risk (>10%). Data were compiled and analyzed using R version 3.4.4 (R Core Team 2013. A language and environment for statistical computing. R foundation for statistical computing, Vienna, Austria. (expressed as percentages) and associations (Chi-squared test and Student's t-test for categorical and continuous data, respectively) were calculated and considered statistically significant at P < 0>

Overall, 516 consenting workers were recruited. Of this, 305 (59.1%) were women. In addition, 236 (45.7%) were permanent workers. They were relatively young (median age 38 years; IQR 32.0–46.8) with a median monthly income of INR 8000 per person. Many lacked any formal education (64.0%) and most (98.8%) had at least one CV risk factor. Among the 58 (11.2%) workers with prior NCD diagnoses, hypertension (49, 9.5%) was most frequently reported. Nonadherence rates were high (56.9%-including 59.1% of hypertensives). Most of those nonadherent cited inaccessible/unavailable healthcare (42.8%) or equated symptomatic relief with cure and subsequently discontinued their medication (31.4%). Use of smokeless tobacco (69.3%) was higher than alcohol (27.1%) and smoked tobacco (16.3%). Among smokers, 90.4% used bidis. Dietary evaluation showed 16.8% consumed fruits and vegetables <5>2 times/week. All workers reported no physical activity outside work. Elevated BP readings (systolic blood pressure >139 or diastolic blood pressure >89) were found in 187 (36.2%), 92 (17.9%) were overweight (BMI ?23), 151 (29.3%) had increased waist circumference, and 414 (80.2%) had raised WHR. Although the mean FRS for all workers was 5.5 (±7.7), 16.6% had an intermediate–high FRS. Men and permanent workers were more likely to have intermediate-high risk than women (29.2% vs. 7.1%, P < 0>P = 0.02), respectively.