A cross-sectional spatial analysis of population attributable fractions for modifiable CVD risk factors in Nigeria

Cardiovascular disease (CVD), the leading global cause of mortality, imposes over 70% of its burden from modifiable risks like high systolic blood pressure, smoking, high body mass index, diabetes, and dyslipidemia. In Nigeria, surging hypertension (30–35%), obesity (25–40%), and diabetes (5–10%) prevalence elevates population attributable fractions (PAFs), yet spatial PAF mapping remains unexplored. This cross-sectional study used 2024 Nigeria Demographic and Health Survey (NDHS) data on tobacco use, alcohol use, high blood pressure (HBP), and high blood sugar (HBS) across 36 states and the FCT. PAFs were calculated using Levin’s formula (tobacco RR = 2.9; alcohol RR = 1.3; HBP RR = 2.5; HBS RR = 2.0), stratified by sex. Anselin’s local Moran’s I identified significant hot- or cold-spot clusters ( p <.05) for precision public health. Women exhibited lower prevalences than men across risks, especially tobacco (max 2.3% women vs. 32.3% men in Anambra) and alcohol (37.1% women in Akwa Ibom vs. 79.2% men in Imo). HBP peaked at 18.6% (women, late 40s) and 13.5% (men, Delta); HBS stayed below 5%. Urban areas showed elevated rates. Southern states dominated hotspots: men’s tobacco PAFs in Edo, Delta, and Cross River; alcohol in Delta, Cross River, and Abia; women’s alcohol in Anambra, Delta, and Bayelsa. HBP showed weak clustering; HBS was random for both sexes. PAFs clustered significantly for alcohol ( I =0.280, p =.002; I =0.266, p =.003), with southern hotspots and northern cold spots. This study reveals southern hotspots for behavioral risks, urging targeted screening and policies in urban and southern Nigeria for equitable CVD prevention.