Unravelling the commercial determinants of cardiovascular risk factors in Ibadan, Nigeria: an exploratory micro-analysis

Cardiovascular diseases (CVD) are a leading cause of death in Nigeria, yet the effect of commercial determinants of health (CDoH) has not been characterized at the individual level. This exploratory study examines the association between CDoH and cardiovascular risk factors in an urban Nigerian community. A community-based survey of 504 adults in Ibadan, Nigeria, obtained information on three cardiovascular risk factors (hypertension, diabetes, and obesity); four CDoH domains (commercial environment, product formulation and design, advertising and marketing practices, regulatory environments); consumption frequencies of predisposing and protective products; and household air pollution. Associations were examined using Pearson’s chi-square tests and multivariate logistic regression, with Firth penalised regression for diabetes. Analyses were conducted at p < 0.05. Hypertension was the most prevalent condition (249/466, 53.4%), followed by obesity (104/467, 22.3%) and diabetes (26/417, 6.2%). Among hypertensive participants, 40.6% were undiagnosed, 43.4% were diagnosed but untreated, and only 2.8% were treated and controlled. Each additional product design attribute reported to influence purchasing was associated with higher odds of hypertension (aOR 1.54, 95% CI 1.09–2.17), as was each decade of age (aOR 1.86, 95% CI 1.39–2.48); employment by a private organisation was associated with lower odds (aOR 0.17, 95% CI 0.03–0.81). Obesity was associated with family history (aOR 4.91, 95% CI 1.52–15.86) and female sex (aOR for male sex 0.09, 95% CI 0.02–0.33). Diabetes was associated with less frequent consumption of fruits and vegetables (aOR 0.72, 95% CI 0.55–0.94) and with tobacco consumption (aOR 3.54, 95% CI 1.33–9.41). Product formulation and design was the only commercial determinant domain associated with hypertension in this community, where hypertension was highly prevalent and largely untreated. These findings support mandatory front-of-pack labelling and product reformulation alongside strengthening of the hypertension care cascade.