The Impact of Structural Barriers on Cardiovascular Disease Risk in the Akha Ethnic Group : A Secondary Moderation Analysis.

Abstract

      This research is an exploratory study aiming to evaluate the role of structural factors (ability to communicate in Thai and barriers to accessing healthcare) as moderators on the relationship between biological risk factors (hypertension) and the risk of cardiovascular disease over the next 10 years among the Akha ethnic group. Data were obtained from 128 Akha adults aged 35–70 years residing in Mae Suai District, Chiang Rai Province. CVD risk was assessed using the Thai CV Risk Score, and logistic regression and moderation analyses were performed using the Hayes Process Macro.

      Results showed that 77.30% of participants were classified as low risk, while 22.60% were at moderate-to-high risk. Hypertension was the only factor significantly associated with higher CVD risk (OR = 3.48, 95% CI = 1.33–9.11, p < .05). Thai language communication ability was significantly associated with lower CVD risk (b = –1.29, p < .001), demonstrating a direct effect, but did not mediate or moderate the relationship between hypertension and CVD risk. Barriers to healthcare access were positively associated with hypertension (b = 0.42, p < .001) but were not associated with CVD risk and showed no significant indirect effect.