Contextual socioeconomic determinants of cardiovascular risk factors in rural south-west China: a multilevel analysis

Three villages were selected from each of the ten townships based on probability proportional to size. In each selected village, 200 individuals aged ≥ 45 years were chosen based on simple random sampling method. From 6006 individuals, information on demographic characteristics, smoking and drinking status was obtained by interview. Blood pressure, height, weight, and waist and hip girth were measured. Fasting blood sugar was measured in a 10-percent subsample. Contextual data were from official reports. Multi-level regression modelling with adjustment for individual and contextual variables was used.Contextual variables associated with CVD risk factors included: remoteness of village with higher blood pressure and fasting blood sugar, high proportion of Yi minority with drinking, high literacy rate with a lower rate of smoking and a lower mean waist-hip ratio, and high average income with lower systolic blood pressure and body mass index (BMI) but higher FBS.While contextual SES is associated with a few CVD risk factors, villages with high level of income are worse off in fasting blood sugar. Strategies of economic development should be reviewed to avoid adverse effects on health.Cardiovascular diseases (CVD) are a major public health concern in the world, accounting for half of all non-communicable disease deaths worldwide [1]. Similar to findings from western countries [2,3], risk factors for CVD in many developing countries have been well recognized [4,5]. Diabetes, hypertension, cigarette smoking, alcohol drinking and overweight have been found to be major risk factors for CVD in China [6-8]. There is also growing evidence that the prevalence of CVD risk factors has been increasing, and clustering of CVD risk factors is common in China [9,10].Traditionally, epidemiological studies have focused on identifying individual-level risk factors for diseases. Recently in epidemiology, there is increasing interest in exploring the effect of population or group (contextu