Risk factors for cardiovascular diseases (CVDs) patients in Bhutan

Abstract

Abstract. This paper aims to identify a survival curve involving risk factors for cardiovascular diseases patients in Bhutan. There are 5,206 cardiovascular diseases patients recorded in Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) medical record department as of January 2006 to December 2016. In addition, it examines a relationship between survival time and some risk factors by using univariate and multivariate Cox's proportional hazard models. Application of Log-rank test and Cox's proportional hazard model compares the survival curves and find the covariates that affects the survival time. The results showed that, during the follow up a total of 844 (16.2%) CVD patients died which 216 (13.3%) was young-aged, 201 (13.7%) a middle-aged and 427 (20.2%) an old-aged. The survivorship curves are plotted using Kaplan Meier method and identified some risk factors using univariate and multivariate Cox's model. The risk factors were identified as, namely, age, sex, frequency of hospital visits, CVD subtype, number of diagnosis, ward, hypertension, diabetes, myocardial infarction, and cerebral infarction. Further, risk factors for each age group are illustrated at the significant p-value <0.05. IntroductionCardiovascular Diseases (CVDs) are the number one cause of death globally and to the less economically developed country like Bhutan. Every year, more number of people die of cardiovascular disease than from any other cause. Cardiovascular Disease (CVD) is the condition that affects the functioning of heart organ and flow of blood in the circulatory system [1]. The competitive risk factors like diabetes, obesity, and the metabolic syndrome contributes to the ascending trend of CVD patients and its mortality. Thus, in the face of public health and individual's economy, it is a huge burden requiring a renewed approach towards prevention of risk factors [2][3][4].Survival models in finding risk factors for cardiovascular patients would be effective in lengthening mortality, treatment and lifestyle modification for CVD patients [5][6][7]. Various studies conducted to frame a risk factors model for short and long terms risk [8]. The association between CVD sub-types and age groups are significant [9][10][11]. Kaplan Meier and Cox's models have widely used to study the relation between CVD's patients and associated risk factors [12][13][14].The aim of this study is to compare the survival function for each age group within covariates and examine the relationship between survival time and risk factors by Cox's proportional hazard models.

An empirical study on factors responsible for Rheumatic Heart Disease (RHD) and its severity levels amongst the Bhutanese populace

“…According to the results of Model 2, there is evidence that age [2] (quadratic term) predicts the incidence of RHD (βAge 2 = 0.004; p < 0.05). This implies that patients' RHD event increases as the age keep increasing and reaches an optimal point and starts declining thereafter.…”

“…CVD is a generic term used for all diseases and conditions associated with heart and blood vessels [1]. The Department of Medical Record, Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) in Thimphu's capital city of Bhutan recorded 5,206 CVD patients in the past eleven years (2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016) [2].…”