Burden of cardiometabolic diseases and depression in a low-income, urban community in Pakistan: a cross-sectional survey

Background: With the rising epidemic of cardiometabolic diseases (CMDs) in low- and middle-income countries, urban populations face unique challenges such as poor sanitation, environmental pollution, and limited access to healthcare. This study estimates the point prevalence of CMDs and associated risk factors in adults in Karachi, analyses CMD prevalence by sex, and explores the relationship between CMDs and depression. Methods: A door-to-door survey was conducted in a densely populated urban community within a 0.5 km radius of a primary health centre. A minimum of 1,480 families were required to estimate the prevalence of CMDs. Depression was screened using PHQ-2 and assessed with PHQ-9. Descriptive analyses summarized family-level sociodemographic data. Sex-specific differences in CMD-related risk factors were analysed using χ² and t-tests. Point prevalence and 95% confidence intervals (CIs) for CMDs were calculated. Bivariate analyses compared cardiometabolic risk factors, healthcare utilization, and mental health across CMD categories. Logistic regression assessed associations between CMDs, demographics, risk factors, and depression. Results: Of the 1,513 families that participated, 3051 adults were included in the analyses. In this stable community (60% residing for more than five years), there was high Urdu (91%) and English (76%) literacy. There was high cell phone ownership (90%) and internet use (81%). Hypertension was the most prevalent CMD (34%). The likelihood of CMD increased with age, rising 49.39 times (95% CI: 30.21 – 80.74; p: < 0.001) higher in those 60 years and above than those aged 18–29. CMD prevalence was strongly associated with depression, compared to those with no CMDs, there were significantly higher odds of mild (OR: 1.89; 95% CI: 1.28 – 2.78; p: < 0.001) and moderate (OR: 2.21; 95%CI: 1.17 – 4.17; p: < 0.014) depression among participants with CMDs. Median health expenditure was 14.2% (IQR: 11.4—26.7%) of monthly income, with increasing CMD burden linked to higher rates of delay in purchasing medications (p: < 0.001). Conclusion: This study highlights the significant burden of CMDs, multimorbidity, and depression in a low-income urban community in Pakistan. The findings suggest that a cardiometabolic multimorbidity (CMM) epidemic is emerging in urban Pakistan, emphasizing the need for integrated interventions addressing physical, mental, economic, and environmental factors in CMD management.