Spatial and Sociodemographic Distribution of Predicted 10‐Year Cardiovascular Disease Risk Among Hypertensive Adults in Bangladesh: Evidence From BDHS 2022

ABSTRACT Cardiovascular disease (CVD) is a major public health problem in Bangladesh, especially among adults with hypertension, yet the sociodemographic patterning, wealth‐related inequities, and spatial distribution of their predicted CVD risk are poorly understood. Using the 2022 Bangladesh Demographic and Health Survey (2544 adults aged ≥18 years; 1412 in the propensity score‐matched sample), we estimated predicted (not overserved) 10‐year CVD risk among adults with hypertension and examined its sociodemographic correlates, wealth‐based inequalities, and geographical clustering. Risk was categorized as low, medium, or high, using a matrix adapted from the World Health Organization/International Society of Hypertension (WHO/ISH) approach, which requires no cholesterol data, and combines hypertension grade, age, sex, recent tobacco use (within 30 min), obesity, and diabetes. Analyses included descriptive and bivariate tests, ordered logistic regression, propensity score matching to assess covariate imbalance across wealth groups, and Global Moran's I and Getis‐Ord Gi* spatial analyses. Overall, 44.7% had low, 18.7% medium, and 36.6% high predicted risk. Older age, female sex, overweight/obesity, recent tobacco use, and higher household wealth were associated with higher predicted risk, although some associations partly reflect the classification rules rather than true differences in risk. In the matched sample, nonpoor participants were slightly more likely than poor participants to have elevated predicted risk (adjusted odds ratio [AOR]: 1.25; 95% confidence interval [CI]: 1.00–1.57), with a stronger association among those with secondary or higher education (AOR: 1.97; 95% CI: 1.09–3.56). Excluding adults under 35 years left most associations and the wealth–education interaction unchanged but altered the education and age effects. Spatial autocorrelation was significant (Global Moran's I = 0.133, p = 0.027), with hotspots in Comilla, Dhaka, Narayanganj, and Narsingdi. These findings concern predicted risk rather than observed cardiovascular events and may support integrating absolute CVD risk assessment into primary care and geographically targeted prevention for hypertensive adults in Bangladesh.