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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 6  |  Issue : 3  |  Page : 99-103

Risk factors for cardiovascular diseases among male workers of building construction site in Delhi


1 Department of Community Medicine, Hamdard Institute of Medical Sciences and Research, New Delhi, India
2 Department of Cardiology, National Heart Institute, New Delhi, India
3 Department of Community Medicine, Vardhman Mahavir Medical College, New Delhi, India

Date of Web Publication4-Jul-2017

Correspondence Address:
Rashmi Agarwalla
Department of Community Medicine, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, Hamdard Nagar, New Delhi - 110 062
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JCPC.JCPC_44_16

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  Abstract 

Background: Cardiovascular disease (CVD) is mainly attributable to a combination of risk factors (RFs): tobacco use, alcohol use, high blood pressure, diabetes, unhealthy diet, and obesity which are amenable to interventions. Building construction workers are poor and vulnerable. They are also the victims of adverse working environmental conditions and subjected to health hazards of occupational origin. Objective: The aim was to study the RFs and associated sociodemographics for CVD among construction site workers. Materials and Methods: This cross-sectional study was conducted among construction site workers. A total of 172 male workers over the age of 18 years were included in the study. Modified World Health Organization Step-wise approach to chronic disease RF surveillance was used to collect data. The data were analyzed in SPSS version 17 and the Chi-square test was applied to analyze the qualitative data. Results: At least one RF for CVD was present in all the subjects, with majority (93.6%) of them having at least two RFs. The presence of the RFs (moderate to high, 3–11) was found to be significantly associated with lower income group, unskilled workers, migration year <1, alcoholics, personal tobacco use, family history of tobacco use, and the low knowledge score regarding tobacco use (0–2). Conclusions: Community-based comprehensive behavioral and life style communication package should be established for workers to reduce the modifiable RFs of CVD.

Keywords: Cardiovascular diseases risk factors, construction site workers, Step-wise Approach to Chronic Disease Risk Factor Surveillance approach


How to cite this article:
Parashar M, Dwivedi S, Agarwalla R, Kishore J, Shaikh Z. Risk factors for cardiovascular diseases among male workers of building construction site in Delhi. J Clin Prev Cardiol 2017;6:99-103

How to cite this URL:
Parashar M, Dwivedi S, Agarwalla R, Kishore J, Shaikh Z. Risk factors for cardiovascular diseases among male workers of building construction site in Delhi. J Clin Prev Cardiol [serial online] 2017 [cited 2019 Jun 26];6:99-103. Available from: http://www.jcpconline.org/text.asp?2017/6/3/99/209383


  Introduction Top


Cardiovascular disease (CVD) and other noncommunicable diseases (NCDs) are becoming the major causes of concern in most of the third world countries,[1] including India. CVD, including strokes, accounts for 31% of all deaths world-wide that is about 15 million deaths a year, of which around 11 million (79%) of these deaths will occur in low- and middle-income countries.[2] Equally affected by the menace, India also contributes toward an ever-increasing proportion of the NCDs in the developing countries.[3] The rapid increase of their burden in most of the low- and middle-income countries is mainly due to the on-going demographic transition of lifestyle related risk factors (RFs).

“Risk” is defined as a probability of an adverse health outcome, whereas “RF” refers to an attribute or characteristic or exposure of an individual whose presence or absence increases the probability of an adverse outcome.[4] A report, jointly prepared by the World Health Organization (WHO) and the World Economic Forum in 2008 had estimated that India will incur an accumulated loss of $236.6 billion by 2015 on account of unhealthy lifestyles and faulty diet.[5] 4.83 million premature deaths in the world were attributed to smoking of which half of them were in developing countries and 3.84 million of these deaths were in men.[6] CVD is found to be more prevalent in Indian urban populations (7%–10%), whereas there is a clear declining gradient in its prevalence from semi-urban to rural populations (3%–5%).[7]

Building construction in urban cities forms the basis of the industrial developments of that area. In India, it is one of the fastest growing industries with an annual growth of 10%.[8] Nearly two-thirds of the contribution to the net domestic product is by the unorganized sector. In India, about 340 million (92%) workers are a part of the unorganized sector and about half of them in construction industry. As per the National Commission for Enterprises in the Unorganized Sector, workers are victims of adverse working environmental conditions and subjected to health hazards of occupational origin.[9],[10] In India, they are mostly migrants from remote villages, often less educated and not cautious about different preventive measures which makes them particularly vulnerable. There is a paucity of epidemiological data on the overall prevalence of many chronic illnesses (including RFs for CVD) in India, especially in the vulnerable group such as construction site workers. Information needs to be collected regarding the need to change the behavior of workers to their own wellness and to provide data to the decision-makers for planning and evaluating effective prevention and control programs and redesigning of health policy and legislation to benefit this group. This study discusses the need for awareness, prevention, and control for CVD RFs among construction site workers in India.

Objective

  1. To estimate the prevalence of RFs for CVD among construction site workers
  2. To find out sociodemographic characteristics associated with the CVD RFs.



  Materials and Methods Top


Study design and study population

A cross-sectional study was conducted among all construction site workers aged 18 years and above in the campus of Hamdard Institute of Medical Sciences and Research and associated HAH Centenary Hospital, New Delhi. Study included all 250 workers working on payroll for 6 months (September 2014–March 2015). One hundred and seventy-two male workers gave consent to participate in the study. Among the rest of the workers, 2% were females and none of them gave consent to participate.

Inclusion criteria

All adult males and females (aged above 18 years) on payroll at construction site in the campus of HAHC Hospital, Jamia Hamdard and those who gave consent to participate were included.

Exclusion criteria

Workers who were of subnormal intelligence and those who were unable to respond to the questions (due to hearing problem or any other reason) were excluded from the study.

Ethical consideration

Necessary permission to conduct the study was obtained from the concerned authority of the construction site. Written informed consent was obtained from the workers after explaining the nature and objectives of this study in their local language. The study was approved by the Institutional Review Board and Institutional Ethical Committee.

Methodology

Data were collected using semi-structured and pretested questionnaire adopted from validated WHO Step-wise Approach to Chronic Disease Risk Factor Surveillance (WHO-STEPS)[11] questionnaires. For each worker, approximately 1 h was required for data collection.

The semi-structured questionnaire included three sections as followings:

  1. Demographic profile: It contained information on age, sex, education, occupation, income of the family, etc.
  2. Behavioral RF: WHO-STEPS instrument covers three different levels of steps of RF assessment. These steps include questionnaire (step-1), physical measurements (step-2), and biochemical measurements (step-3). It included questions on the sociodemographic status, data on tobacco and alcohol use, measures of dietary habits, family history, and duration of migration years. Physical activity was not assessed as the study was done among construction site worker who fall under the category of heavy workers. All surveys were administered by local medical professionals, who were trained in research survey methods. Standard procedures were followed for anthropometric and blood pressure (BP) measurements. The RFs considered were use of tobacco, use of alcohol, nicotine dependence, unhealthy diet, overweight, abdominal obesity, hypertension, prediabetes, diabetes mellitus, anemia, and electrocardiogram (ECG) changes. The weight of the individual (correct to 0.5 kg) and height (correct to 0.1 cm) were measured. Individual subjects standing height and weight (bare footed) were taken as per the standard method.[12] Investigations such as ECG, random blood sugar, and hemoglobin were performed free of cost in the HAH Centenary Hospital only. Cholesterol estimation was not performed because of the high cost for the test.


Operational definitions

  • Illiterate: Those who could not read or write in any particular language with proper understanding
  • Current smokers/smokeless tobacco user: Current daily smokers/smokeless tobacco users were defined as those who were currently smoking daily or using smokeless tobacco daily
  • Current alcoholic: Current alcohol consumption was defined as one or more than one drink of alcohol consumed daily, one or more times in 1 week
  • BMI: Overweight was defined as body mass index (BMI) ranging from 23 to 24.9 and obesity as BMI ≥25. The BMI was calculated using the following equation WHO [13]
  • BP: Based on a systolic BP ≥140 mm of Hg or diastolic BP ≥90 mm of Hg. BP was measured in the supine position using mercury sphygmomanometer.[14] All measurements were taken at cardiac OPD of HAHC hospital
  • Hb estimation: By acid hematin method (Sahli's)[15]
  • Healthy diet: Consumption of at least one serving of vegetables and fruits daily was considered as having a healthy diet [16]
  • Abdominal obesity: Waist circumference of ≥90 cm in men and ≥85 cm in women was taken as obesity [17]
  • Nicotine dependence: It was assessed by Fagerstrom nicotine dependent score [18]
  • Diabetes: Fasting plasma glucose value ≥7.0 mmol/L (126 mg/dl). Impaired glucose tolerance and impaired fasting glycaemia were also taken as risk categories for future development of diabetes and CVD.[19]


The questionnaire was administered anonymously and it had been maintained. The study purpose was explained to all eligible participants and verbal consent was obtained from all who agreed to participate. Following completion of the questionnaires, all participants were given a token of appreciation (free medicines if required) and appropriate treatment (counseling/pharmacotherapy) based on the RF score interpretation from the WHO adopted STEP approach questionnaire and biochemical findings in the tobacco cessation clinic of the hospital. They were referred to appropriate department for the identified health problem.

Statistical analysis

The data were analyzed in SPSS Inc. Released 2008. SPSS Statistics for Windows, Version 17.0. (SPSS Inc., Chicago) and the Chi-square test was applied to analyze the qualitative data. Mean values of continuous variables such as BMI, waist circumference, BP, were calculated. Sample for RF for CVD was categorized into two groups: those with minimal RF (<3), and those with moderate to high RF (>3). Chi-square test was used to evaluate the associations among RF and the sociodemographic variables.


  Results Top


A total of 172 males participated in the study. The mean age of the workers was 32.04 ± 11.6 years. Among the workers, majority (91%) were tobacco users and out of these slightly less than two-third (62.8) were using tobacco. More than two-thirds (72.1) of the study population were laborers, 24.4% were semiskilled and skilled laborers and only 3.5% were involved in other type of work at construction site. Most of the workers (94.1%) were migrants. Notably, more than two-third (70.9%) were married workers and nuclear family (97%) was the predominant type among them.

With regards to presence of each of the eleven RFs, risk was found in all the workers with majority (93.6%) of the population having at least two RFs, with a significantly higher prevalence of tobacco use (91%) followed by unhealthy diet (79%) and nicotine dependence (51%) among them.

[Table 1] shows the prevalence of WHO-STEPS instrument parameters among construction site workers. It was found that majority of the participants (n = 156, 91%) were tobacco users; 49% were using smokeless tobacco, 29% were smoking bidi/cigarette and 22% were smokers as well as tobacco chewers. Among the tobacco users, 51% were moderate to severe nicotine dependent. About one-fifth (24.4%) of the study participants consumed alcohol, and nearly 79% were taking unhealthy diet. Around one-third (31.9%) were hypertensive and slightly less than two-fifth (37.2%) were having abnormal ECG.
Table 1: Prevalence of parameter of cardiac risk factor assessment (n=172)

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Among the workers <35 years of age, the prevalence of moderate to high RF of CVD was 15.3% compared to 24.6% among workers of over the age of 35 years. Among alcoholics, workers with minimal RF (9.47%) were much lower than that of alcoholics with clustering of RFs (90.4%). The differences between alcoholics and nonalcoholics was statistically significant (P = 0.000). On univariate analysis, presence of RFs (moderate to high) was found to be significantly associated with lower income group, unskilled workers, alcoholics, family history of tobacco use, migration year <1, tobacco use, low knowledge score regarding tobacco use [Table 2].
Table 2: The influence of sociodemographic characteristics on cardiac risk factor

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  Discussion Top


The prevalence of more than two score of RFs was found very high among the workers. A study carried out by Prabhakaran et al. in a selected relatively young male population in an industrial setting from north India also revealed the high prevalence of behavioral RFs among workers.[20] As per his finding, half of the of the industrial workers had at least two of the RF for CVD. Another study by Mehan et al. identified a total of 34.1% of the workers as being at risk (>3 RF).[21] The reasons for high prevalence of RF's in our study could be the different study settings and methodology adopted, like our study showed prevalence of workers having more than 2 RFs, while other study by Mehan et al. showed the prevalence of more than 3 RFs.

In the present study, the prevalence of tobacco use was found to be 91% among the workers.

The prevalence of smoking and tobacco chewing were 29% and 49%, respectively, whereas 22% were using both. As per Akram et al. in Mangalore among industrial workers, prevalence of tobacco use was 53.7% and prevalence of smoking, tobacco chewing was found to be 11.9% and 41.8%, respectively.[22] Another study carried out by Laad et al. revealed the prevalence of tobacco users to be 63.8%.[23] Ansari et al. found prevalence of tobacco use among power loom workers in Mau Aima Town, Allahabad district to be 85.9% and the prevalence of smoking and tobaccos chewing among them were 62.28% and 66.07%, respectively.[24]

Prevalence of overweight and abdominal obesity in our study was not high as found in similar other studies among workers.[21],[25],[26] Difference could be due to the presence of nature of job which requires a lot of physical work in construction activity. High prevalence of hypertension (25.5%) and abnormal ECG suggestive of cardiac problem was observed in our study which is a worrying feature in this group. Similar findings are reported from other work setting-based studies.[26],[27] This might be due to the less awareness level among workers about CVD and the absence of regular screening program at workplace. Thus, health education among workers and also sensitizing policy makers for advocating screening at workplace can improve early detection and management. Prevalence of diabetes, alcohol consumption in our study was found to be similar to that found in other studies.[26],[28]

Anemia was found in more than one-tenth of the workers. We observed that only one in five consumed healthy diet and the quantity consumed was lower than recommended. This is in accordance with findings from study on South Asians.[29] This emphasizes need to improve awareness among workers to increase consumption of locally available cheap fruit and vegetable intake.

Limitations

Although the study provides reliable information about underprivileged population, there may be some limitations. The study was carried out among male workers only in one construction site in Delhi, and hence the sample size is small and the results cannot be generalized to other populations. As the behavioral RFs were studied through self-reporting, some of the information may be concealed. Furthermore, cholesterol levels could not be assessed due to the lack of financial resources. Despite these limitations, the study indicates that this segment of population is also vulnerable to CVD because of their behavior.


  Conclusions Top


The present study showed a high burden of behavioral RFs for CVD among construction site workers in Delhi, pointing toward changing disease epidemiology of CVD. The RFs were found to be prevalent in all participant workers and across all socioeconomic classes. Although National Program for Prevention and Control of Diabetes, CVD and stroke has been launched, strict and optimal implementation particularly for this group is not practiced. Considering the high burden of CVD RFs in this population, there is urgent need to work on community-based interventions for specific population groups at various levels including health promotion, prevention, early diagnosis, treatment, and rehabilitation. Interventions such as awareness regarding behavioral RF modification (abstinence from tobacco, well-balanced diet, stress management, etc.) are required to improve cardiovascular health. The challenge is to prevent acquisition of harmful health behaviors during the course of socioeconomic development, especially among the lower socioeconomic younger vulnerable populations. Therefore, there is also a need to relook at health policies focusing on behavior change, and communication to promote healthy diets and lifestyles among workers, especially at unorganized construction site.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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