Bipolar Disorder and Cardiovascular Risk in Rural versus Urban Populations in Colombia: A Comparative Clinical and Epidemiological Evaluation

• Main Authors: Juan Pablo Forero (Author), Alexander Ferrera (Author), Jose Daniel Castaño (Author), Sergio Ardila (Author), Tanya Mesa (Author), Dean Hosgood (Author), Eugenio Ferro (Author)
• Format: Book
• Published: Ubiquity Press, 2021-11-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 2214-9996; 10.5334/aogh.3479
• Keywords: Infectious and parasitic diseases; RC109-216; Public aspects of medicine; RA1-1270
• Source: Annals of Global Health, Vol 87, Iss 1 (2021)

Background: Various multifactorial elements may contribute toward the urban and rural disparities in cardiovascular disease (CVD) risk, particularly among patients with psychiatric diseases. Objective: To investigate whether rural patients diagnosed and treated for Bipolar Disorder (BD) have different risk profiles and outcomes of CVD compared to urban (BD) patients. Methods: We conducted a case-control study that included 125 BD patients (cases) from rural Filadelfia, Colombia and 250 BD patients (controls) treated in Bogotá, Colombia. Cases and controls were 2:1, matched by age and sex. We applied the Framingham Heart Study (FHS) risk calculator to assess risk. Differences by rural/urban status (i.e., case-control status) were assessed by chi-square, paired t-tests, and logistic regression. Findings: Rural BD patients were found to have lower education (p = 1.0 × 10-4), alcohol consumption (p = 3.0 × 10-4), smoking (p = 0.015), psychiatric (p = 1.0 × 10-4) and CV family history (p = 0.0042) compared to urban BD patients. Rural BD patients were 81% more likely to have a more favorable CVD risk profile (OR: 0.19, 95% CI [0.06-0.62]) than urban BD patients, despite rural BD patients having increased CVD morbidity (p = 1.0 × 10-2). Conclusion: Based on increase in morbidity but lower predictive risk in the rural population, our study suggests that the FHS-CVD calculator may not be optimal to assess CVD risk in this population.