ASSESSMENT OF NON-COMMUNICABLE
DISEASE RISK FACTORS IN A RURAL PARISH
OF ECUADOR
EVALUACIÓN DE LOS FACTORES DE RIESGO DE ENFERMEDADES
NO TRANSMISIBLES EN UNA PARROQUIA RURAL DE ECUADOR
Carlos Vinicio Erazo Cheza
Pontificia Universidad Católica del Ecuador
Raul Ruiz De Zarate Del Cueto
Pontificia Universidad Católica del Ecuador
Víctor Hugo Mena Maldonado
Pontificia Universidad Católica del Ecuador
Gonzalo Eduardo Montero Moretta
Pontificia Universidad Católica del Ecuador
Nelly Guadalupe Sarmiento Sarmiento
Pontificia Universidad Católica del Ecuador
pág. 14554
DOI: https://doi.org/10.37811/cl_rcm.v9i5.20673
Assessment of Non-Communicable Disease Risk Factors in a Rural Parish
of Ecuador
Carlos Vinicio Erazo Cheza1
cverazo@puce.edu.ec
https://orcid.org/0000-0001-7908-4144
Full-time professor
Researcher at PUCE School of Medicine
PUCE Institute of Public Health
Master's Degree in Epidemiology
Family Medicine
Pontificia Universidad Católica del Ecuador
PUCE, Quito
Raul Ruiz De Zarate Del Cueto
rruizdezarate408@puce.edu.ec
https://orcid.org/0000-0002-3975-6839
Full-time professor
PUCE School of Medicine
Master in Longevity Sciences
Specialist in Internal Medicine
Pontificia Universidad Católica del Ecuador
PUCE, Quito
Víctor Hugo Mena Maldonado
abp.vhmena@gmail.com
https://orcid.org/0000-0002-4487-4290
Full-time professor PUCE School of Medicine
IDIS Community Professor, Outreach Projects
Specialist in Family Medicine
Pontificia Universidad Católica del Ecuador
PUCE, Quito
Gonzalo Eduardo Montero Moretta
gmontero2014@gmail.com
https://orcid.org/0000-0002-6804-6836
Full-time professor PUCE School of Medicine
IDIS Community Professor, Outreach Projects
PHD in Collective health, environment and
society
Pontificia Universidad Católica del Ecuador
PUCE, Quito
Nelly Guadalupe Sarmiento Sarmiento
nsarmientos@puce.edu.ec
https://orcid.org/0000-0002-7778-6182
Full-time professor PUCE School of Medicine
IDIS Community Professor, Outreach Projects
Master’s degree in public health
Pontificia Universidad Católica del Ecuador
PUCE, Quito
.
1
Autor principal
Correspondencia: cverazo@puce.edu.ec
pág. 14555
ABSTRACT
Background: Chronic noncommunicable diseases, including cardiovascular diseases, are a public health
problem in the world and are one of the leading causes of mortality worldwide, approximately 17.9
million deaths per year [1]. The growth of these diseases is even more evident in low- and middle-
income countries (LMICS), countries in which health systems face problems of prevention and health
promotion [2]. In Ecuador, rural populations are not free from the presence of these diseases but data
and information on risk factors for the development of noncommunicable diseases is scarce [3].
Methods: This cross-sectional study assessed behavioral, anthropometric, and biochemical risk factors
among 1,568 adults in La “Independencia”, Ecuador, using the WHO STEPSwise approach [4]. Data
were collected on socioeconomics, smoking, alcohol consumption, diet, physical activity, body mass
index (BMI), blood pressure, fasting glucose and total cholesterol. Statistical analysis included
descriptive and inferential tests to evaluate associations between demographic and clinical variables
[5]. Results: The prevalence of risk factors for the development of chronic noncommunicable diseases
such as cardiovascular disease found in this study were: behavioral risk factors included daily smoking
(40.69%), alcohol consumption (45.07%), and low consumption of fruits and vegetables (76.59%).
Physical measures identified high rates of abdominal obesity (50.51%), general obesity (34.25%), and
elevated blood pressure (20.34%). Laboratory measurements highlighted a prevalence of elevated
glucose (41.26%) and elevated cholesterol (73.47%). [9]. Conclusions: Our findings highlight the need
for targeted public health interventions that address modifiable risk factors in rural Ecuador. Strategies
should focus on health promotion programs, improve access to health care to mitigate cardiovascular
risks [10].
Keywords: cardiovascular risk factors, non-communicable diseases, WHO STEPS, Ecuador, rural
health
pág. 14556
Evaluación de los Factores de Riesgo de Enfermedades no Transmisibles en
una Parroquia Rural de Ecuador
RESUMEN
Antecedentes: Las enfermedades crónicas no transmisibles, incluidas las enfermedades
cardiovasculares, constituyen un problema de salud pública a nivel mundial y representan una de las
principales causas de mortalidad, con aproximadamente 17.9 millones de muertes por año [1]. El
crecimiento de estas enfermedades es aún más evidente en los países de ingresos bajos y medianos
(PIBM), donde los sistemas de salud enfrentan dificultades en la prevención y la promoción de la salud
[2]. En Ecuador, las poblaciones rurales no están exentas de estas enfermedades; sin embargo, la
información disponible sobre los factores de riesgo asociados a su desarrollo es limitada [3]. Métodos:
Este estudio transversal evaluó factores de riesgo conductuales, antropométricos y bioquímicos en 1,568
adultos residentes de la parroquia La “Independencia”, Ecuador, utilizando la metodología STEPS de
la Organización Mundial de la Salud (OMS) [4]. Se recopilaron datos sobre variables socioeconómicas,
consumo de tabaco y alcohol, dieta, actividad física, índice de masa corporal (IMC), presión arterial,
glucosa en ayunas y colesterol total. El análisis estadístico incluyó pruebas descriptivas e inferenciales
para evaluar las asociaciones entre variables demográficas y clínicas [5]. Resultados: La prevalencia de
factores de riesgo para el desarrollo de enfermedades crónicas no transmisibles, como las enfermedades
cardiovasculares, fue alta. Entre los factores conductuales se identificó consumo diario de tabaco
(40.69%), consumo de alcohol (45.07%) y bajo consumo de frutas y verduras (76.59%). Las medidas
físicas mostraron altas tasas de obesidad abdominal (50.51%), obesidad general (34.25%) y presión
arterial elevada (20.34%). Los análisis bioquímicos evidenciaron prevalencia de glucosa elevada
(41.26%) y colesterol elevado (73.47%) [9]. Conclusiones: Los hallazgos destacan la necesidad de
intervenciones de salud pública dirigidas a los factores de riesgo modificables en zonas rurales del
Ecuador. Se recomienda fortalecer los programas de promoción de la salud y mejorar el acceso a los
servicios sanitarios con el fin de reducir los riesgos cardiovasculares [10].
Palabras Clave: factores de riesgo cardiovascular, enfermedades no transmisibles, metodología STEPS
de la OMS, Ecuador, salud rural
Artículo recibido 27 septiembre 2025
Aceptado para publicación: 29 octubre 2025
pág. 14557
INTRODUCTION
Cardiovascular diseases (CVDs) remain the leading cause of death worldwide, claiming an estimated
17.9 million lives annually. A striking 77% of these deaths occur in low- and middle-income countries
(LMICs), where structural inequalities and under-resourced health systems contribute to a growing
burden of non-communicable diseases (NCDs) [1][2]. These conditions are often preventable, yet
persist due to a complex interplay of social, economic, and environmental factors.
In Latin America, this public health transition is particularly evident. While infectious diseases once
dominated mortality statistics, NCDs now account for the majority of deaths. Rapid urbanization,
changes in dietary patterns, and increasingly sedentary lifestyles have led to rising rates of hypertension,
obesity, and type 2 diabetes. These shifts affect both urban and rural populations, though not equally.
In many cases, rural communities bear a disproportionate burden due to limited access to healthcare
services and preventive strategies [3][4].
Ecuador follows this regional trend. According to national estimates, around 68% of all deaths are
attributed to NCDs, with cardiovascular conditions representing a significant portion. Surveys such as
ENSANUT and WHO STEPS have helped document health risks at the national level, particularly in
urban contexts. However, data on rural populations remain sparse, limiting efforts to design
interventions that reflect the realities of these communities [5][6][7].
The rural parish of “La Independencia” in Esmeraldas Province exemplifies the challenges faced by
underserved regions. Home to both Mestizo and Afro-Ecuadorian populations, the area relies heavily
on agricultural work, often under precarious economic conditions. Access to healthcare is limited, and
social determinants such as poverty and low levels of formal education create environments in which
modifiable CVD risk factors—like smoking, poor diet, and physical inactivity—are common and
largely unaddressed [8][9].
Studies across Latin America have shown that rural populations often experience higher rates of tobacco
use, obesity, and insufficient physical activity, compared to their urban counterparts [10][11]. These
disparities are shaped by cultural norms, infrastructural gaps, and inconsistent public health policies.
Despite this, Ecuador lacks specific data on these trends in its rural regions, leaving a critical void in
public health planning and policy [12].
pág. 14558
This study aims to address this gap by analyzing the prevalence and distribution of CVD risk factors
in “La Independencia.” Applying the WHO STEPwise approach, it assesses behavioral, anthropometric,
and biochemical indicators to generate evidence that can inform targeted community-level strategies
and support broader health policy development.
METHODS
Study Design and Setting
This was a cross-sectional, community-based study conducted between October 2018 and May 2019 in
“La Independencia”, Esmeraldas Province, Ecuador. This rural parish is home to approximately 7,000
residents, predominantly mestizo and Afro-Ecuadorian. The local economy is centered on agriculture,
and the community experiences significant socioeconomic disparities [8][13].
Adults aged ≥18 years who had resided in “La Independencia” for at least six months were eligible to
participate. Pregnant women, individuals with severe illness, and those unwilling to provide informed
consent were excluded. Rather than employing census-based household visits, the study followed a
census approach. The research team visited each household across all identified neighborhoods in “La
Independencia”. Adults meeting the inclusion criteria were invited to participate, and informed consent
was obtained before data collection. This approach ensured a broad representation of the community
while prioritizing voluntary participation and ethical compliance.
Adults aged ≥18 years who had resided in “La Independencia” for at least six months were eligible to
participate. Pregnant women, individuals with severe illness, and those unwilling to provide informed
consent were excluded [4][14].
This approach sampling ensured representation from both central and peripheral neighborhoods. The
sampling was designed to capture a diverse demographic profile, accounting for variations in
socioeconomic status and healthcare access [15].
Sample Size
A sample size of 1,568 was calculated using a 95% confidence level, a 1.45% margin of error, and an
estimated overweight/obesity prevalence of 31% in rural Ecuador [5]. This sample size provided
sufficient statistical power to analyze subgroup differences.
pág. 14559
Data Collection
The WHO STEPSwise questionnaire was carefully adapted to the cultural and socioeconomic context
of a rural parish, “La Independencia”. For example, questions about dietary intake were adjusted to
include local staples and traditional eating habits. Additionally, the terminology was simplified and
translated to Spanish to ensure clarity and comprehension among participants, many of whom had
limited formal education.
Behavioral Risk Factors: The WHO STEPSwise questionnaire was adapted to collect data on:
Tobacco Use: Defined as current daily smoking or use of smokeless tobacco.
Alcohol Consumption: Hazardous drinking was categorized as ≥15 drinks/week for men and ≥8
drinks/week for women [16].
Dietary Intake: Low fruit/vegetable intake was defined as fewer than five servings per day [17].
Physical Activity: Measured using the Global Physical Activity Questionnaire (GPAQ), with inactivity
defined as <150 minutes of moderate activity/week [18].
Anthropometric and Physical Measurements:
To ensure the quality and precision of the measurements, all field personnel underwent rigorous training
sessions on data collection protocols. Instruments such as digital scales and automated blood pressure
monitors were standardized and calibrated prior to and during the data collection period. Regular
supervisory visits were conducted to verify adherence to protocols and address any discrepancies.
Body Mass Index (BMI): Calculated as weight (kg)/height (m²). Obesity was defined as BMI ≥30[19].
Waist Circumference: Abdominal obesity was defined as >102 cm in men and >88 cm in women [20].
Blood Pressure: Hypertension was defined as systolic ≥140 mmHg or diastolic ≥90 mmHg, measured
with three readings averaged.
Biochemical Measurements: Fasting glucose and cholesterol levels were measured. Hyperglycemia was
defined as fasting glucose ≥126 mg/dL, and hypercholesterolemia as total cholesterol ≥200 mg/dL.
RESULTS
The final sample included 1,568 participants, with a mean age of 42.7 ± 17 years. Women represented
60.3% of the study population, and the majority (88.4%) identified as mestizo. Educational attainment
was generally low; over half of the participants (55.8%) had completed only primary education.
pág. 14560
In terms of occupation, most individuals reported working in agricultural or informal sectors, consistent
with the rural profile of the study site [16].
Several modifiable cardiovascular risk factors were identified. Tobacco use was reported by 40.7% of
participants, with a significantly higher prevalence among men (46.7%) than women (35.1%; p < 0.01).
Alcohol consumption was reported by 45.1%, with hazardous drinking behaviors particularly
concentrated among men (57.3%). Poor dietary patterns were also widespread, as 76.6% of participants
consumed insufficient amounts of fruits and vegetables, slightly more prevalent among women.
Regarding anthropometric and clinical findings, 34.3% of participants met the criteria for obesity, with
significantly higher rates among women (41.9%). Hypertension was present in 20.3% of the sample,
with a notable age-related increase, reaching 37% among older adults.
Biochemical markers revealed elevated levels of cardiovascular risk: 41.2% had hyperglycemia, rising
to 52% in older individuals, while hypercholesterolemia affected 38.9% of the sample, with no marked
gender differences [21][22].
Table 1 Position
Table 1 Socio-demographic information on participants in study of cardiovascular disease risk factors,
La Independencia, Ecuador, 2018
Socio-demographic variables
Female (N = 946 - 60.33%)
Both Genders (N =
1568)
n
%
n
%
n
%
Age group
18–29
262,00
27,70
179,00
28,78
441,00
28,13
30–44
313,00
33,09
160,00
25,72
473,00
30,17
45–59
214,00
22,62
143,00
22,99
357,00
22,77
≥ 60
157,00
16,60
140,00
22,51
297,00
18,94
Total
946,00
60,33
622,00
39,67
1568,00
100,00
Education
No formal schooling
112,00
11,88
63,00
10,19
175,00
11,21
Primary school
513,00
54,40
358,00
57,93
871,00
55,80
Secondary school
63,00
6,68
52,00
8,41
115,00
7,37
Higher education
255,00
27,04
145,00
23,46
400,00
25,62
Total
943,00
60,41
618,00
39,59
1561,00
100,00
Ethnicity
Indigenous
6,00
0,64
8,00
1,29
14,00
0,90
Afroecuatoriano
43,00
4,56
54,00
8,71
97,00
6,21
Mestizo
856,00
90,87
525,00
84,68
1381,00
88,41
Other
37,00
3,93
33,00
5,32
70,00
4,48
Total
942,00
60,31
620,00
39,69
1562,00
100,00
pág. 14561
Marital Status
Never married
241,00
25,53
178,00
28,66
419,00
26,77
Currently married or cohabitating
578,00
61,23
407,00
65,54
985,00
62,94
Widowed or separated
125,00
13,24
36,00
5,80
161,00
10,29
Total
944,00
60,32
621,00
39,68
1565,00
100,00
Occupation/labour market
position/status
Student
55,00
5,84
36,00
5,80
91,00
5,83
Self-employed
182,00
19,34
253,00
40,74
435,00
27,85
Employed
127,00
13,50
220,00
35,43
347,00
22,22
Housewife or homemaker
487,00
51,75
6,00
0,97
493,00
31,56
Retired
7,00
0,74
19,00
3,06
26,00
1,66
Unemployed
83,00
8,82
87,00
14,01
170,00
10,88
Total
941,00
60,24
621,00
1562,00
100,00
Table 2 Position
Table 2 Prevalence of cardiovascular disease risk factors stratified by socio-demographic variables,
La Independencia, Ecuador, 2018
STEP 1: Behavioural Risk Factors (%, 95 CI)
STEP 2: Physical Measurements (%,
95 CI)
STEP 3:
Laboratory Measureme
nts (%, 95 CI)
Socio-demographic
variables
Current
daily
smoker
Current
alcohol
consumption
Low fruit and
vegetable
consumption
Low level
of physical
activity
Overweight
Obesity
Abdominal
obesity
Raised
blood
pressure
Glucose
elevated
Cholesterol
elevated
Prevalencia total
40,69(32,61-
49,15)
45,07(41,62-
48,54)
76,59(74,41-
78,67)
41.07(38,62-
43,55)
37,82(35,41-
40,27)
34,25(31,90-
36,65)
50,51(48,00-
53,01)
20,34(18,38-
22,42)
41,26(38,81-
43,74)
73,47(71,21-
75,64)
Gender
Female
44,00 (24,40-
65,07)
35,10(30,70-
39,69)
79,39(76,77-
81,92)
37,31(34,22-
40,48)
35,94(32,88-
39,09)
41,96(38,80-
45,18)
65,96(62,84-
68,98)
18,28(15,87-
20,90)
37,33(34,64-
40,91)
73,25(70,31-
76,05)
Male
40,00(31,17-
49,34)
57,34(52,10-
62,44)
72,34(68,65-
75,83)
46,78(42,81-
50,79)
40,67(36,79-
44,65)
22,50(19,28-
25,99)
27,00(23,56-
30,68)
23,47(20,19-
27,00)
46,62(42,65-
50,63)
73,79(70,15-
77,21)
Age group
18–29
26,31(13,40-
43,10)
51,59(45,60-
57,54)
75,97(71,69-
79,88)
36,96(32,44-
41,65)
31,97(27,64-
36,55)
21,08(17,37-
25,20)
29,93(25,69-
34,44)
4,70(29,71-
71,87)
56,23(51,46-
60,92)
72,10(67,67-
76,25)
30–44
40,00 (24,86-
56,67)
50,88(44,90-
56,84)
76,53(72,45-
80,28)
45,45(40,90-
50,06)
40,59(36,13-
45,17)
41,64(37,16-
46,24)
56,65(52,06-
61,18)
19,00(15,59-
22,86)
41,23(36,75-
45,81)
72,72(68,47-
76,69)
45–59
46,15(30,094-
62,82)
31,54(24,60-
39,15)
76,75(72,02-
81,03)
39,21(34,12-
44,49)
41,17(36,02-
46,48)
40,05(34,93-
45,34)
61,06(55,79-
66,15)
27,45(22,88-
32,39)
31,65(26,86-
36,75)
75,63(70,83-
79,99)
≥ 60
53,57(33,87-
72,49)
31,03(21,54-
41,86)
77,44(72,26-
82,07)
42,42(36,73-
48,26)
38,04(32,50-
43,83)
35,01(29,60-
40,74)
58,58(52,75-
64,24)
37,03(31,53-
42,80)
30,64(25,44-
36,22)
74,07(68,70-
78,96)
Education
No formal
schooling
61,90(38,43-
81,89)
22,64(12,28-
36,21)
73,71(66,54-
80,07)
45,71(38,18-
53,40)
31,43(24,63-
38,86)
46,85(39,29-
54,53)
62,85(55,24-
70,03)
31,42(24,63-
38,86)
35,42(28,36-
43,00)
77,14(70,20-
83,14)
Primary school
34,61(24,20-
46,24)
50,79(46,33-
55,25)
76,69(73,74-
79,46)
42,13(38,83-
45,49)
37,19(33,98-
40,50)
30,88(27,83-
34,07)
45,80(42,46-
49,18)
15,61(13,26-
18,20)
45,46(42,12-
48,84)
71,75(68,64-
74,72)
Secondary school
25,00(06,30-
80,59)
57,75(45,44-
69,39)
74,78(65,83-
82,41)
55,65(46,09-
64,91)
49,56(40,11-
59,04)
21,73(14,59-
30,40)
40,00(30,98-
49,55)
16,52(10,25-
24,59)
47,82(38,42-
57,34)
77,39(68,65-
84,67)
Higher education
41,46(26,31-
57,89)
31,77(25,25-
38,86)
78,00(73,61-
81,96)
32,75(28,17-
37,59)
38,75(33,95-
43,72)
39,25(34,43-
44,22)
58,00(52,99-
62,89)
26,75(22,47-
31,37)
32,5(27,93-
37,33)
74,25(69,67-
78,47)
Ethnicity
Indigenous
0,00(0,00-
97,5)*
28,57(03,67-
70,96)
50,00(23,04-
76,96)
42,85(17,66-
71,13)
64,28(35,14-
87,24)
35,71(12,76-
64,86)
64,28(35,14-
87,24)
14,28(01,78-
42,81)
42,85(17,66-
71,14)
92,85(66,13-
99,82)
Afroecuatoriano
56,52(34,49-
76,80)
44,07(31,15-
57,60)
72,16(62,14-
80,79)
36,08(26,57-
46,46)
32,98(35,14-
87,24)
26,80(18,31-
36,76)
37,11(27,52-
47,52)
23,71(15,66-
33,42)
54,64(44,21-
64,78)
79,38(69,97-
86,93)
Mestizo
39,13(30,16-
48,67)
45,58(41,91-
49,29)
77,48(75,18-
79,66)
41,63(39,02-
44,29)
38,01(35,45-
40,63)
34,68(32,17-
37,26)
51,26(48,59-
53,93)
20,13(18,04-
22,34)
39,60(37,02-
42,24)
72,84(70,42-
75,18)
Other
16,66(04,21-
64,12)
40,74(22,39-
61,20)
71,42(59,38-
81,59)
37,14(25,89-
49,52)
35,71(24,61-
48,07)
37,14(25,89-
49,52)
52,85(40,55-
64,91)
22,85(13,66-
34,45)
54,28(41,94-
66,25)
72,85(60,90-
82,80)
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Marital Status
Never married
21,21(89,80-
39,90)
50,00(43,14-
56,86)
78,28(74,02-
82,14)
35,79(31,20-
40,60)
31,98(27,54-
36,68)
26,73(22,55-
31,24)
37,23(3259-
42,06)
16,70(13,26-
20,63)
45,82(40,98-
50,73)
71,36(66,77-
75,64)
Currently married
or cohabitating
47,06(37,10-
57,19)
44,51(40,25-
48,82)
75,73(72,93-
78,38)
43,53(40,43-
46,71)
40,91(37,82-
44,06)
36,64(33,63-
39,74)
54,21(51,04-
57,36)
20,00(13,26-
20,63)
40,81(37,72-
43,95)
74,01(71,15-
76,72)
Widowed or
separated
40,00(12,15-
73,76)
34,84(23,53-
47,58)
77,01(69,74-
83,27)
38,50(30,96-
46,49)
34,16(26,88-
42,04)
38,50(30,96-
46,49)
62,11(54,14-
69,63)
31,67(24,58-
39,46)
32,30(25,15-
40,11)
75,15(67,74-
81,62)
Occupation/labour
market
position/status
Student
0,00(0,00-
0,84)*
50,91(37,07-
64,65)
78,02(68,11-
86,03)
26,37(17,68-
36,65)
16,48(09,53-
25,72)
23,07(14,89-
33,09)
26,37(17,68-
36,65)
04,39(01,21-
10,87)
42,85(32,53-
53,66
63,73(52,99-
73,56)
Self-employed
46,27(33,99-
58,88)
52,00(45,61-
58,34)
71,49(67,00-
75,92)
44,83(40,09-
49,64)
41,37(36,71-
46,17)
34,02(29,58-
38,68)
46,89(42,13-
51,71)
25,74(21,70-
30,13)
39,31(34,69-
44,07)
73,33(68,91-
77,43)
Employed
32,69(20,33-
47,10)
54,31(47,66-
60,84)
78,38(73,68-
82,60)
51,58(46,19-
56,95)
41,21(35,98-
46,59)
24,20(19,79-
29,07)
34,00(29,03-
39,25)
15,85(12,17-
20,12)
48,70(43,33-
54,10)
75,79(70,93-
80,21)
Housewife or
homemaker
57,14(28,86-
82,34)
27,15(21,40-
33,52)
78,29(74,39-
81,85)
32,86(28,73-
37,20)
36,71(32,45-
41,13)
45,03(40,58-
49,54)
70,99(66,77-
74,96)
18,45(15,13-
22,17)
38,94(34,62-
43,41)
74,03(69,93-
77,85)
Retired
N/A
66.67(09,43-
99,15)
65,38(44,33-
82,78)
57,69(36,92-
76,65)
46,15(26,59-
66,63)
30,77(14,33-
51,79)
57,69(36,92-
76,65)
26,92(11,57-
47,79)
34,61(17,21-
55,67)
73,07(52,21-
88,43)
Unemployed
33,33(74,85-
70,07)
40,35(27,56-
54,18)
82,35(75,78-
87,76)
38,82(31,46-
46,59)
35,29(28,13-
42,98)
30,00(23,22-
37,49)
45,88(38,23-
53,68)
29,41(22,68-
36,87)
37,06(29,79-
44,79)
71,76(64,36-
78,39)
DISCUSSION
To address these gaps, targeted interventions that include culturally sensitive health promotion
programs, enhanced community involvement, and infrastructure development are crucial. For example,
successful tobacco control campaigns in rural Colombia and dietary interventions in Peru offer models
for adaptation in Ecuador. Furthermore, gender disparities demand specific strategies, such as
increasing opportunities for physical activity among women and addressing the social acceptance of
tobacco use among men. Structural barriers, including economic constraints and limited healthcare
access, need policy-level solutions to reduce health inequities in rural settings.
A deeper understanding of the structural barriers in rural settings is essential. These include limited
access to healthcare, economic instability, and inadequate policy enforcement that exacerbate health
disparities. For example, rural communities often face geographic isolation and lack of transportation,
which hinder access to preventive services.
The high prevalence of cardiovascular risk factors observed in “La Independencia” is deeply rooted in
structural determinants such as poverty, limited access to healthcare, and low levels of education. These
factors create barriers to healthy living, including inadequate access to nutritious foods and safe spaces
for physical activity. Addressing these structural issues requires multi-sectoral approaches that integrate
health, education, and economic development policies.
pág. 14563
For instance, investment in infrastructure, such as transportation networks and healthcare facilities, can
improve access to preventive and curative services. Furthermore, community-led initiatives can
empower residents to address local challenges effectively.
We present here an in-depth analysis of modifiable cardiovascular disease (CVD) risk factors in “La
Independencia,” Ecuador. The findings reveal a high prevalence of tobacco use, alcohol consumption,
low fruit and vegetable intake, obesity, and biochemical abnormalities. These results align with trends
observed in rural Latin America, but also present unique features shaped by the local sociocultural and
economic context.
Comparison with Previous Studies
The prevalence of tobacco use (40.7%) in “La Independencia” significantly exceeds the national
average reported in urban Ecuador (13.7%) and mirrors findings from rural Colombia, where rates of
37% have been observed [16][17]. This difference may reflect weaker enforcement of tobacco control
policies in rural areas, combined with cultural norms that normalize smoking, particularly among men
[18]. Similarly, alcohol consumption (45.1%) aligns with patterns reported in rural Peru and Bolivia,
where hazardous drinking is closely tied to occupational stress and social traditions [19][20].
The low fruit and vegetable intake (76.6%) is consistent with studies across rural Latin America, where
economic constraints and limited agricultural diversity restrict access to fresh produce [21]. In Ecuador,
regional disparities in food security exacerbate these dietary challenges, with rural households often
relying on high-calorie, low-cost processed foods [22].
Obesity rates (34.3%) in “La Independencia” are comparable to findings from rural Colombia and Brazil
but exceed the prevalence reported in urban Ecuador (26%) [23][24]. The gender disparity, with women
exhibiting significantly higher rates of obesity (41.9% vs. 22.5% in men), reflects broader sociocultural
dynamics in Latin America, where caregiving roles, limited mobility, and dietary patterns
disproportionately affect women [25][26].
Explaining Discrepancies and Patterns
The observed gender differences in risk factors highlight the influence of cultural norms on health
behaviors. Higher tobacco and alcohol use among men may be attributed to social acceptability and
occupational stress in agricultural settings, where men are more likely to engage in physically
pág. 14564
demanding labor [27]. Conversely, the higher prevalence of obesity and abdominal obesity among
women highlights the cumulative impact of caregiving responsibilities, reduced access to recreational
spaces, and restricted opportunities for physical activity [28][29].
Age-specific trends are also notable. Older adults (≥60 years) exhibited markedly higher rates of
hypertension (37%), hyperglycemia (52%), and hypercholesterolemia (38.9%). These findings align
with the cumulative effect of unmanaged risk factors over time, compounded by limited healthcare
access in rural areas [30][31]. In contrast, younger adults (18–29 years) reported higher tobacco and
alcohol use, reflecting the early adoption of harmful behaviors driven by cultural and social influences
[32][33].
Implications for Public Health
Successful examples from similar settings include tobacco taxation initiatives in rural Colombia, which
reduced smoking rates, and community-led dietary education programs in Peru that improved fruit and
vegetable consumption. Adapting such models to Ecuador’s rural context could address the observed
disparities.
CONCLUSIONS
This study sheds light on the significant burden of cardiovascular risk factors in the rural community of
La Independencia. The high prevalence of tobacco and alcohol use, poor dietary patterns, obesity,
hypertension, and metabolic disorders such as hyperglycemia and hypercholesterolemia signals a
growing public health challenge in underserved areas of Ecuador.
While the situation is complex, the findings point to practical and realistic entry points for action.
Community-based health promotion—especially when culturally adapted and led by trusted local
figures—can be an effective strategy to improve awareness and encourage healthier behaviors related
to diet, physical activity, and substance use [34][35].
In addition, integrating low-cost screening and early detection services into existing rural healthcare
systems is both feasible and impactful. Mobile clinics, community health brigades, or telemedicine
could support the identification and management of hypertension, diabetes, and dyslipidemia in settings
with limited infrastructure [38].
pág. 14565
At the policy level, these local data can support broader advocacy efforts. Strengthening regulations
around tobacco and alcohol, improving access to affordable healthy food, and addressing marketing of
unhealthy products remain essential to tackling structural determinants of health [36][37].
Finally, this study contributes baseline evidence to guide future public health planning, and highlights
the need for continued research—both quantitative and qualitative—to understand how rural
communities in Ecuador experience and respond to cardiovascular risk factors over time.
Limitations and Future Directions
Future studies should investigate the long-term impact of community-based interventions on reducing
cardiovascular risk factors in rural Ecuador. Additionally, qualitative studies exploring barriers to
healthy lifestyles can provide insights into cultural and social determinants.
Future research should explore the implementation and outcomes of culturally adapted interventions in
rural Ecuador. Longitudinal studies could assess the impact of community-based programs on
cardiovascular risk reduction over time. Qualitative research could uncover deeper insights into the
lived experiences and health-related behaviors of rural populations.
This study’s cross-sectional design limits the ability to establish causal relationships between risk
factors and outcomes. Additionally, reliance on self-reported data for behavioral factors may introduce
recall or social desirability bias. Despite these limitations, the use of the WHO STEPSwise approach
ensures comparability with other studies and provides a robust framework for understanding risk factor
prevalence.
Future research should focus on longitudinal studies to track changes in CVD risk factors over time and
evaluate the impact of targeted interventions. Comparative analyses between rural and urban
populations within Ecuador would also provide valuable insights into regional disparities and inform
national strategies [39][40].
Ethics Statement
This study was approved by the Ethics Committee of the Pontificia Universidad Católica del Ecuador
(PUCE) and the Ministry of Public Health of Ecuador, CEISH-574-2018. All participants provided
informed consent prior to data collection. The study adhered to ethical principles outlined in the
Declaration of Helsinki for research involving human subjects.
pág. 14566
Funding
This research was supported by internal funding from the Pontificia Universidad Católica del Ecuador
(PUCE). No external funding sources were used for this study.
Conflict of Interest Statement
The authors declare there are no conflicts of interest related to this study.
Author Contributions
Carlos Vinicio Erazo: Principal author and corresponding author. Responsible for the conceptualization
and planning of the study, statistical analysis, manuscript writing, and overall project supervision.
Raúl Ruíz de Zárate del Cueto: Contributed to data collection, analysis of sociodemographic variables,
and critical review of the manuscript.
Gonzalo Montero: Participated in the methodological design, preparation of the theoretical framework,
and analysis of results. Contributed to writing the results section.
Victor Hugo Mena: Managed administrative tasks for the study, coordinated with local authorities for
participant recruitment, and critically reviewed the manuscript.
Nelly Sarmiento: Assisted in the collection and processing of biochemical data, preliminary drafting of
the discussion section, and final manuscript review.
Acknowledgements
We must thank the collaboration of the group of promoters of the rural community of “La
Independencia” who were always accompanying in the process and supporting with all the necessary
means for the adequate work of the researchers and collaborators during the development of it,
voluntarily and spontaneously for the good of their community.
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