A multicentric cross-sectional survey to assess cardiovascular risk factors among persons working in informal gold mines in French-Guiana - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Official websites use .gov A .gov website belongs to an official government organization in the United States. Secure .gov websites use HTTPS A lock ( Lock Locked padlock icon ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites. Search Log in Dashboard Publications Account settings Log out Search… Search NCBI Primary site navigation Search Logged in as: Dashboard Publications Account settings Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide PERMALINK Copy As a library, NLM provides access to scientific literature. 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Learn more: PMC Disclaimer | PMC Copyright Notice BMC Public Health . 2026 Mar 12;26:1293. doi: 10.1186/s12889-026-26723-8 Search in PMC Search in PubMed View in NLM Catalog Add to search A multicentric cross-sectional survey to assess cardiovascular risk factors among persons working in informal gold mines in French-Guiana Guillaume Alexandre Terrentroy Guillaume Alexandre Terrentroy 1 Centre Hospitalier Universitaire de Guyane, Cayenne, French Guiana 2 Centre d’Investigation Clinique Guyane Amazonie , Inserm 1424, Cayenne, French Guiana Find articles by Guillaume Alexandre Terrentroy 1, 2, ✉ , Yann Lambert Yann Lambert 1 Centre Hospitalier Universitaire de Guyane, Cayenne, French Guiana 2 Centre d’Investigation Clinique Guyane Amazonie , Inserm 1424, Cayenne, French Guiana 3 UA17, Santé des Populations en Amazonie, Cayenne, French Guiana Find articles by Yann Lambert 1, 2, 3 , Louise Hureau-Mutricy Louise Hureau-Mutricy 1 Centre Hospitalier Universitaire de Guyane, Cayenne, French Guiana 2 Centre d’Investigation Clinique Guyane Amazonie , Inserm 1424, Cayenne, French Guiana Find articles by Louise Hureau-Mutricy 1, 2 , Muriel Galindo Muriel Galindo 1 Centre Hospitalier Universitaire de Guyane, Cayenne, French Guiana 2 Centre d’Investigation Clinique Guyane Amazonie , Inserm 1424, Cayenne, French Guiana Find articles by Muriel Galindo 1, 2 , Antoine Adenis Antoine Adenis 1 Centre Hospitalier Universitaire de Guyane, Cayenne, French Guiana 2 Centre d’Investigation Clinique Guyane Amazonie , Inserm 1424, Cayenne, French Guiana 3 UA17, Santé des Populations en Amazonie, Cayenne, French Guiana Find articles by Antoine Adenis 1, 2, 3 , Mathieu Nacher Mathieu Nacher 1 Centre Hospitalier Universitaire de Guyane, Cayenne, French Guiana 2 Centre d’Investigation Clinique Guyane Amazonie , Inserm 1424, Cayenne, French Guiana 3 UA17, Santé des Populations en Amazonie, Cayenne, French Guiana Find articles by Mathieu Nacher 1, 2, 3 , Stephen Vreden Stephen Vreden 4 Foundation for the Advancement of Scientific Research, Paramaribo, Suriname Find articles by Stephen Vreden 4 , Maylis Douine Maylis Douine 1 Centre Hospitalier Universitaire de Guyane, Cayenne, French Guiana 2 Centre d’Investigation Clinique Guyane Amazonie , Inserm 1424, Cayenne, French Guiana 3 UA17, Santé des Populations en Amazonie, Cayenne, French Guiana Find articles by Maylis Douine 1, 2, 3 Author information Article notes Copyright and License information 1 Centre Hospitalier Universitaire de Guyane, Cayenne, French Guiana 2 Centre d’Investigation Clinique Guyane Amazonie , Inserm 1424, Cayenne, French Guiana 3 UA17, Santé des Populations en Amazonie, Cayenne, French Guiana 4 Foundation for the Advancement of Scientific Research, Paramaribo, Suriname ✉ Corresponding author. Received 2025 Oct 30; Accepted 2026 Feb 13; Collection date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13097911 PMID: 41820970 Abstract Background Cardiovascular diseases are the leading cause of death worldwide. French Guiana has a high prevalence of these diseases, responsible for high morbidity. The persons involved in informal gold mining sites in French Guiana are subject to poor health determinants. Various studies have shown their precariousness and their susceptibility to infectious diseases. However, no studies have ever assessed their cardiovascular risk factors. The aim of this work was to describe the cardiovascular risk factors among this specific population and notably factors associated with High Blood Pressure (HBP). Methods A cross-sectional, descriptive, multicenter study was carried out at six logistical rear bases of gold mining at the French Guiana-Suriname border. Adults who worked at an illegal gold mining site, were out from the site for less than 7 days, and agreed to participate in the study were included. Participants answered a questionnaire on their lifestyle and past medical history, underwent a medical examination, and physical data were collected. Results Between October and December 2019, 380 participants were included, with a sex ratio M/F = 2.7. Mean age was 39.9 years. They were mostly Brazilian (95.5%). Cardiovascular risk factors were numerous: 2% [IC: 0.7–3.5] with diabetes, 21% [IC: 15.7–25.9] with blood pressure ≥ 140/90 mmHg, 43% [IC: 35–53] overweight (BMI > 25 kg/m2), 48% [IC: 43–53] abdominally obese. Toxic consumption was high: 58% had excessive alcohol consumption and 39% used tobacco. The Ottawa cardiovascular risk score was calculated “high” in 39% of the population. Excluding age, 89% of participants had at least one cardiovascular risk factor. Multivariate analysis showed that men were at greater risk of hypertension than women (OR = 1.48 [1.03 – 3.81], p = 0.041); as well as those aged over 39 (OR = 1.68 [1.17 – 3.08], p = 0.039); those who had been mining for more than 10 years ( OR = 1.64 [1.01 – 3.02], p = 0.011), those with abdominal obesity ( OR = 2.24 [1.24 – 4.77], p < 0.01) and those with diabetes (OR = 2.82 [1.62 – 12.8], p = 0.024). Conclusion The prevalence of cardiovascular risk factors was higher than expected in this rather young population, who migrate for economic reasons and should therefore be in good health. The prevalence of various pathologies is worrying, reinforcing their overall precariousness. It remains essential to strengthen health promotion in this population to tackle these various cardiovascular risk factors. Trial registration Clinical Trial registration number NCT03695770 , registred on February 10, 2018. Keywords: Illegal gold-miners, French Guiana, Neglected population, Cardiovascular diseases, Cardiovascular risk factors, High blood pressure, Vulnerable population Background The burden of cardiovascular diseases has been on the rise since the 1990s. They represent the world's leading cause of death, with around 17.9 million deaths a year according to the WHO [ 1 ]. These diseases are responsible for around 10,000 deaths a day in Europe and are the second leading cause of death in France [ 2 , 3 ]. The high healthcare costs associated with cardiovascular diseases are high and have a major impact on the healthcare system [ 4 ]. French Guiana is the largest French overseas territory and is located in Northeastern South America. Most of the territory (90%) is covered by Amazon rainforest. Suriname lies to the west, Brazil to the south and east, and the Atlantic Ocean to the north (Fig. 1 ). In this remote French territory, cardiovascular risk factors and diseases are numerous and higher than in France, resulting in a changing death profile [ 5 ]. Stroke is the leading cause of death in French Guiana [ 6 , 7 ]. Premature deaths (before 65 years) are frequent [ 8 ]. Poverty, from which half the inhabitants of French Guiana suffer, could represent an additional cardiovascular risk factor [ 9 , 10 ]. Fig. 1. Open in a new tab Inclusion sites of participant in the Orpal2 Study in 2019 French Guiana is also known for illegal gold mining, which exploded in the 1990 s [ 11 ]. Individuals working on these gold mining sites, known as “Garimpeiros”, constitute a specific population. There are approximately 10,000 workers from neighboring countries, mainly from Brazil, operating in an estimated 500 to 700 gold mines located deep within the forest. They are highly mobile within the Guiana Shield region [ 12 , 13 ], a mobility further enhanced by gold rushes and law‑enforcement interventions [ 14 ]. Garimpeiros are exposed to multiple diseases, such as infectious diseases (malaria, leishmaniasis, leptospirosis), dermatological, musculoskeletal or digestive disorders and wildlife encounters [ 14 – 17 ]. One in three is estimated to have high blood pressure, according to a 2015 study [ 16 ]. The prevalence of other cardiovascular diseases or cardiovascular risk factors remains unknown. Over the years, various epidemics have occurred in succession, such as Shigella Flexneri diarrhea in 2013, “Beriberi” in 2015, and rabies resulting in three deaths in 2024 [ 18 – 20 ]. Moreover, these individuals have limited access to healthcare because of fear of the police and the remoteness of the mining sites, located several hours or even days from health centers. They hence often resort to self-medication, which can lead to drug interactions and the selection of resistant pathogens [ 21 ]. In this context, although health research conducted among individuals working on illegal gold mining sites in French Guiana has primarily focused on infectious diseases, we hypothesized that cardiovascular risk factors might also represent substantial and neglected health problems in this population. The Orpal2 study was a cross‑sectional study initially implemented to document the burden of malaria among persons working on illegal gold mining sites in French Guiana after implementing an interventional project (Malakit project) [ 22 ]. Within this framework, a secondary objective was added to describe the prevalence of cardiovascular risk factors and to identify factors associated with high blood pressure, a highly prevalent condition with major cardiovascular implications, in order to improve health promotion in this population. Methods Study design The Orpal2 cross-sectional study was conducted between October and December 2019 along the border between French Guiana and Suriname. Sample size was calculated based on the primary effectiveness outcome, defined as behaviour in response to malaria-like symptoms before and after implementation of the Malakit public health intervention at the population level [ 22 ]. Assuming a baseline prevalence of inappropriate self-medication of 50%, a total sample size of 860 participants was required to detect a minimum absolute reduction of 5 percentage points, using a two-sided test with an alpha level of 0.05 and 80% statistical power, corresponding to a target sample size of 430 participants on each side of the French Guiana borders. Because no sampling frame was available, random sampling could not be implemented. Participants were therefore recruited through opportunistic encounters combined with a snowball sampling approach. Participants Inclusions took place at logistical rear bases located on the border between French Guiana and Suriname, where participants can trade or rest. These bases often include hotels, bars, and stores. Gold-mining sites are located at varying distances from these logistical rear bases, from less than 2 h to more than a day's walk. Inclusion criteria were age over 18, working on an illegal gold-mining site in French Guiana, having been present at the logistical rear bases for less than seven days, not having previously participated in the study, and having completed the written consent form. Due to the informal and highly mobile nature of the gold mining population and the absence of a sampling frame, the number of eligible individuals approached but declining participation could not be reliably recorded. Consequently, a conventional response rate could not be calculated. Data collection Data collection was anonymous and was carried out́ by a professional team, composed of a nurse, a health mediator and a physician. Data were collected with a digital tablet, then stored on a secure server and imported into an Excel database. Variables The socio-demographic data collected were: place of recruitment, sex, age, country and state of birth, education level, health insurance coverage in France (statutory health insurance or State Medical Aid). Occupational data collected were duration of work in gold mining (in years), work rhythm (diurnal, nocturnal, both), activity on the sites, accessibility of work sites (i.e. distance in time between the gold mining site and the inclusion site), mode of access to the site (on foot, by all-terrain vehicle (ATV), by pirogue, by plane, other). Previously diagnosed diabetes or High Blood Pressure (HBP) were assessed by self-report, as well as access to health care and chronic treatment. The variables capturing risk behaviors collected were the frequency of alcohol consumption, the number of standard drinks consumed in a day and the frequency of consumption of six standard drinks. The other risk behavior variables were consumption of marijuana, crack, cocaine, tobacco and the number of pack-years [ 23 ]. Blood pressure (BP) was measured by a trained nurse using a validated and calibrated electronic wrist sphygmomanometer, after 15 min of seated rest. In participants with an initial BP ≥ 140/90 mmHg, a second measurement was performed after an additional 15 min of rest, and the lowest value was retained for analysis. Other medical data collected were weight (in kg), height (in meter), waist circumference (in cm), and capillary blood glucose [ 24 , 25 ]. As participants were recruited at logistical rear bases, inclusion could occur at any time of the day; therefore, most participants were in a non-fasting state at the time of inclusion. Definitions HBP was classified according to the recommendations as ≥ 140/90 mmHg, Alcohol consumption was used to compile the AUDIT-C score (Alcohol Use Disorders Identification Test-Consumption) which is an alcohol consumption score derived from the AUDIT created by the WHO to determine whether a person consumes alcohol excessively (a score ≥ 3 for women or ≥ 4 for men) [ 26 ]. As participants were recruited at logistical rear bases, inclusion could occur at any time of the day; therefore, most participants were in a non‑fasting state at the time of inclusion. According to international recommendations, probable diabetes was defined as a random plasma glucose level ≥ 2.0 g/L (11.1 mmol/L) or a self‑reported previous diagnosis of diabetes made by a health professional [ 27 – 29 ]. Body mass index (BMI) was calculated as weight divided by height squared (kg/m2) and categorized as underweight (< 18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), obesity class I (30.0–34.9 kg/m2), obesity class II (35.0–39.9 kg/m2), and obesity class III (≥ 40.0 kg/m2). Abdominal obesity was assessed using waist circumference, applying two commonly used cut‑off values: ≥ 94 cm in men and ≥ 80 cm in women to identify increased cardiometabolic risk, and > 102 cm in men and > 88 cm in women according to the NCEP ATP III criteria [ 24 , 30 ]. Metabolic syndrome was defined according to the NCEP ATP III criteria, based on waist circumference (> 102 cm in men and > 88 cm in women), elevated blood glucose (≥ 2 g/L), and elevated blood pressure (≥ 130/85 mmHg), with dyslipidemia intentionally excluded from the definition in this study) [ 31 , 32 ]. The 10-year cardiovascular risk was estimated using the Ottawa score [ 33 ], as described in Additional File 1, which provides detailed definitions of all score components. People with HBP or probable diabetes were given dietary guidelines and lifestyle advice and were referred to health professionals. Statistical analysis Continuous variables were described using median and interquartile (based on the median or according to the literature) and average. Qualitative variables were described in terms of frequencies and proportions. Confidence intervals were calculated at the 95% level using standard methods based on the distribution of the estimated parameters. Univariable analysis was performed using Chi-2 tests or Fisher's exact test for small sample sizes ( n < 5). A p -value < 0.05 was considered significant. A multivariable logistic regression analysis was performed to identify factors independently associated with high blood pressure, selected as an outcome of interest due to its high prevalence and well‑documented cardiovascular implications. Variables associated with high blood pressure in univariable analysis ( p < 0.20) were considered for inclusion in the multivariable model, based on known associations reported in the literature and biological plausibility. Results were expressed as crude odds ratios (OR) and adjusted ORs with their 95% Confidence Intervals. Descriptive and univariable analyses were performed using P Value.io software and multivariable analysis using Jamovi software. Results Sociodemographic data Between October 1 and December 31, 2019, 380 participants were included in the study. Recruitment was conducted at five logistical hubs—Antonio do Brinco (194/380), Albina (110), the Grand-Santi area (Ampoema and Texas; n = 52), Yaopassi ( n = 18), and Lawa Tabiki ( n = 6) (see Fig. 1 ). These sites function as rear logistical bases and transit hubs for a highly mobile gold-mining population, allowing the inclusion of participants originating from 20 distinct mining regions, each comprising several to dozens of gold-mining camps.Two hundred and seventy-eight (73.1%) were men and 102 (26.9%) were women (Table 1 ). The average age was 39.9 years. Three hundred and sixty-three participants were born in Brazil (95.5%), 50% of them were from the Brazilian State of Maranhão. We included 195 people from Maripasoula, 108 in Albina, 45 in Grand-Santi, 18 in Yao-Passi, and 14 in Papaichton. Table 1. Socio-demographic data on persons included at the border between French Guiana and Suriname from October to December 2019 n = 380 (%) CI (95%) Sex Men 278 (73.1%) [68.7–77.6] Woman 102 (26.9%) [22.3–31.3] Pregnant woman Yes 14 (3.7%) [1.8–5.6] Age (Years) 18—34 131 (34.5%) [29.7–39.2] 35—49 169 (44.5%) [39.5–49.5] 50—64 79 (20.8%) [16.7–24.9] > 65 1 (0.02%) [0.0–0.8] Place of inclusion Albina 108 (28.5%) [23.9–33] Grand-Santi 45 (11.8%) [8.6–15.1] Maripasoula 195 (51.3%) [46.2–56.3] Yao-Passi 18 (4.7%) [2.6–6.9] Papaichton 14 (3.7%) [1.8–5.6] Country of birth Brazil 363 (95.5%) [93.4–97.6] Dominican Republic 7 (2%) [0.5–3.2] Other 10 (2.5%) [1.0–4.2] Brazilian State of origin Maranhão 202 (55.6%) [50.5–60.7] Para 79 (21.8%) [17.5–26.1] Other 82 (22.6%) [18.3–26.9] Education level None/Primary 131 (34.5%) [29.7–39.2] Secondary/Higher education 249 (65.5%) [60.7–70.3] Health insurance CMU/AME 10 (2.5%) [0.9–4.1] No 366 (96%) [94.4–98.2] Don’t know 4 (1.5%) [0.0–6.2] Time in goldmining (In years) < 1 29 (7.7%) [4.9–10.3] 1–2 21 (5.5%) [3.2–7.8] 2–5 67 (17.6%) [13.8–21.5] > 5 263 (69.2%) [64.5–73.8] Distance between gold mining site and inclusion site < 2 h 29 (7.6%) [5.0–10.3] 2 h to half a day 117 (32.8%) [26.1–35.4] 1 day 92 (24.2%) [19.9–28.5] > 1 day 98 (25.7%) [21.4–30.2] Don’t know 37 (9.7%) [6.8–12.7] Mode of travel By foot 217 (57.1%) [52.1–62.1] Boat 346 (91%) [88.2–93.9] ATV 1 48 (12.6%) [9.3–15.9] Car/Moto/Plane 20 (5.3%) [3.1–7.5] Mining technique Alluvial 250 (65.7%) [60.7–70.1] Well 71 (18.7%) [13.5–23.8] Alluvial/Well 43 (11.3%) [8.1–14.5] Open sky/Dredger 16 (4.3%) [2.2–6.2] Work schedule Daytime only 288 (75.8%) [70.7–80.9] Night only 8 (2.1%) [0.0–7.2] Both 84 (22.1%) [16.9–27.2] Occupation (22 participants had 2 jobs) n = 380 (%) Gold miner 230 (60.5%) [54.2–64.2] Site manager 120 (31.6%) [22.3–39.8] Boatman 19 (5%) [2.9–6.7] Other 33 (8.7%) [3.52–12.2] Open in a new tab 1 All-terrain Vehicle The majority (96.3%) had no French health insurance coverage. Two hundred and sixty-three (69.2%) had been working in gold mining for more than five years. Their main occupations were gold miner (60.5%), site manager (31.6%), and boatman (5%). Cardiovascular risk factors Overweight or obesity was found in 165 participants (43.4% [38.5–48.5]); 182 (48.0% [43.0–53.0]) had an abdominal circumference beyond the threshold (117 men (64%) had an abdominal circumference ≥ 94 cm and 65 women (36%) had an abdominal circumference ≥ 80 cm) (Table 2 ). Among participants older than 40, 21 men (11%) and 37 women (20%) were abdominally obese, versus 18 men (13%) and 29 (54%) among participants younger than 40 ( p = 0.04 and p = 0.57, for men and women respectively). Table 2. Anthropometric and clinical data from the 380 participants in the Orpal2 study n = 380 (%) CI (%) Non-fasting capillary blood glucose < 2 g/L 377 (99.2%) [94.1–100.0] Probable diabetes Yes 8 (2.1%) [0.7–3.5] Blood pressure < 140/90 mmHg 301 (79.2%) [74.1–84.3] ≥ 140/90 mmHg 79 (20.7%) [15.7–25.9] Abdominal obesity 1 n = 3 79 (%) 2 No 197 (51.9%) [46.8–57.1] Yes 182 (48%) [43,–53] Abdominal obesity (Men) 117 (30.7%) [27.2–34.2] Abdominal obesity (Women) 65 (17.1%) [11.7–22.6] BMI (kg/m 2 ) n = 377 (%) 3 < 18.5/Underweight 6 (1.5%) [0.00–6.7] 18.5–24.9/Normal 206 (54.6%) [49.6–59.6] 25–29.9/Overweight 136 (36.4%) [31.2–40.9] 30–34.9/Obesity 1 15 (3.9%) [2.1–5.9] 35–39.9/Obesity 2 13 (3.4%) [1.6–5.2] > 40/Obesity 3 1 (0.2%) [0.0–0.9] Open in a new tab 1 Abdominal circumference ≥ 80 cm for women and ≥ 94 cm for men 2 One missing data 3 Three missing datas In bold are the significant results Three participants (1%) had random blood glucose levels ≥ 2 g/L; two reported having previously been diagnosed with diabetes, while the third met the study criteria for probable diabetes based on elevated random blood glucose levels, although additional biological investigations would have been required to confirm the diagnosis. Seven participants reported a past history of diabetes, of whom four were receiving treatment, and three had been off treatment for several months. Overall, a total of eight people were classified as having probable diabetes, corresponding to a prevalence of 2.1% [1.1–4.1]. One fifth (79/380, 20.8% [17.7–25.9]) had a blood pressure above 140/90 mmHg. Of these, eight were already known hypertensives, three of whom were under treatment and five of whom had discontinued therapy. No patient with a known history of high blood pressure had a normal blood pressure at the time of inclusion. Nine women (8.8%) and two men (0.8%) met the criteria corresponding to our definition of a metabolic syndrome, i.e. prevalence of 2.9% [1.6–5.1] (11/380). Regarding alcohol consumption, 220 (58% [52.9–62.8]) were excessive drinkers. These included 165 men (75%) and 55 women (25%). One hundred and forty-seven (39% [33.8–43.6]) smoked (Table 3 ). Table 3. Alcohol, tobacco and drugs and consumption among our 380 participants in the oral study 3 n = 380 (%) CI (%) Excessive drinking Yes 220 (58%) [52.9–62.8] Excessive drinking Men Yes 165 (59%) [53.6–65.1] Excessive drinking Women Yes 55 (54%) [44.2–63.6] Tobacco consumption Yes 147 (39%) [33.8–43.6] No 229 (60%) [55.3–65.2] Don’t know 55 (54%) [44.2–63.6] Marijuana Daily 15 (3.9%) [1.9–5.9] Once a week 12 (3.2%) [1.4–4.9] Occasional 13 (3.4%) [1.6–5.2] Never 340 (89%) [86.4–92.6] Cocaïne Once a week 2 (0.53%) [0.0–1.25] Occasional 1 (0.26%) [0.0–0.7] Never 377 (99%) [98.32–100] Crack Once a week 2 (0.53%) [0.0–1.22] Occasional 2 (0.53%) [0.0–1.21] Never 376 (99%) [93.8–199] Open in a new tab Global cardiovascular risk Regardless of age, 337 (89%) had one or more cardiovascular risk factors, 31% of the participants had more than two risk factors, and 9% had more than three. Only 43 participants (11%) had no risk factors (Table 4 ). The Ottawa score showed that 39% [33.5–43.4] (145/377) had a high cardiovascular risk and 48% [42.4–52.5] (179/377) had a moderate cardiovascular risk. Table 4. Number of cardiovascular risk factor per participant (without age) Number of risk factors 1 Men ( n = 278(%)) Women ( n = 102(%)) n = 380 (%) 0 34 (12%) 9 (8%) 43 (11%) 1 70 (25%) 16 (16%) 86 (23%) 2 100 (36%) 32 (30%) 132 (35%) 3 55 (20%) 30 (29%) 85 (22%) ≥ 4 19 (7%) 15 (17%) 34 (9%) Open in a new tab The cardiovascular risk factors considered here are: High blood pressure, tobacco consumption, abdominal circumference ≥ 80 cm for women, ≥ 94 cm for men, probable diabetes, AUDIT-C alcohol consumption score ≥ 3 for women, ≥ 4 for men, a BMI ≥ 25 kg/m2) Factors associated with high blood pressure The univariable analysis showed evidence of an association between HBP and male sex ( p = 0.028; OR = 2.11 [1.12–4.18]), age over 40 years old ( p < 0.01; 0R = 2.10 [1.25–3.60]), having worked in gold mining for more than 10 years ( p < 0.001; OR = 2.97 [1.75–5.16]), working as gold miner (stricto sensu) ( p = 0.020; OR = 1.95 [1.13–3.48]), and probable diabetes ( p = 0.042; OR = 3.08 [1.12–13.1]). In multiple logistic regression, variables associated with HBP were male sex (aOR = 1.48, [1.03–3.81]), age over 40 (aOR = 1.6, [1.17–3.08]), time spent in gold mining longer than 10 years (aOR = 1.64, [1.01 3.02]), the presence of abdominal obesity (aOR = 2.42, [1.24–4.77]) and probable diabetes (aOR = 2.82, [1.62–12.8]) (Table 5 ). Table 5. Uni and multi-variate analysis of factors associated with High Blood Pressure among people working in in gold mines in French Guiana (2019) Univariable analysis Multivariable analysis Variables HBP – n = 301 HBP + n = 79 OR 1 (IC 2 ) P -value 3 aOR 4,5 (IC 6 ) P -value Sex Women 87 (85%) 15 (15%) 1 - 1 - Men 214 (77%) 64 (23%) 2.11 [ 1.12–4.18 ] 0.028 1.48 [ 1.03–3.81 ] 0.041 Age 18–39 years 172 (90%) 19 (10%) 1 - 1 - > 39 years 129 (68%) 60 (32%) 2.10 [ 1.25–3.60 ] < 0.01 1.68 [ 1.17–3.08 ] 0.039 Country of birth Brazil 286 (79%) 77 (21%) 1 - - - Other 15 (89%) 2 (12%) 1.31 [0.361–3.84] 0.64 - - Duration in gold mining ≤ 10 years 177 (85%) 30 (15%) 1 - 1 - > 10 years 123 (71%) 49 (29%) 2.97 [ 1.75–5.16 ] < 0.001 1.64 [ 1.01–3.02 ] 0.011 Main profession Other 123 (82%) 27 (18%) 1 - 1 - Gold-miner 178 (77%) 52 (23%) 1.95 [ 1.13–3.48 ] 0.020 1.79 [0.85–4.08] 0.14 Work rhythm Day only 220 (78%) 62 (22%) 1 - - - Night only/Both 74 (81%) 17 (19%) 0.85 [0.45–1.54] 0.611 - - BMI < 25 kg/m 2 180 (83%) 32 (17%) 1 - - - Overweight 101 (74%) 35 (26%) 1.01 [0.58–1.77] 0.960 - - Obesity 18 (62%) 11 (38%) 1.69 [0.67–3.96] 0.247 - - Abdominal obesity 6 No 167 (85%) 30 (15%) 1 - 1 - Yes 133 (73%) 49 (27%) 1.50 [0.83–2.60] 0.170 2.42 [ 1.24–4.77 ] < 0.01 Ottawa Score Low 42 (88%) 10 (12%) 1 - - - Moderate 149 (83%) 30 (17%) 0.90 [0.8–2.12] 0.75 - - High 107 (72%) 38 (28%) 1.53 [0.67–3.75] 0.32 - - Probable diabetes No 297 (80%) 75 (20%) 1 - 1 - Yes 4 (50%) 4 (50%) 3.08 [ 1.12–13.1 ] 0.042 2.82 [ 1.62–12.8 ] 0.024 Alcohol consumption Not excessive 119 (74%) 41 (26%) 1 - - - Excessive 182 (83%) 38 (17%) 1.06 [0.63–1.78] 0.815 - - Tobacco No 180 (79%) 49 (21%) 1 - - - Yes 118 (89%) 29 (20%) 0.98 [0.57–1.67] 0.968 - - Open in a new tab In bold are the significant results 1 Odds Ratio 2 Confidence Interval 3 Chi2 or Fisher 4 Adjusted Odds Ratio 5 Logistical regression 6 Abdominal circumference ≥ 80 cm for women and ≥ 94 cm for men No significant interaction between age and time in gold mining was found. Given the high prevalence of obesity, we sought to identify factors associated with this condition. We performed a simple logistic regression to analyze the factors associated with obesity. In univariate analysis, male gender (OR = 0.26; 95% CI [0.12–0.57]; p = 0.001), gold panning (sensu stricto) (OR = 0.26; 95% CI [0.12–0.60]; p = 0.001) and smoking (OR = 0.39; 95% CI [0.16–0.99]; p = 0.047) were associated with a lower risk of obesity. High blood pressure ( p = 0.25; OR = 1.66 [0,70–3,94]), Alcohol consumption ( p = 0.52; OR = 1.29 [0,59–2,82]), Ottawa Score ( p = 0.19; OR = 1.50 [0,82–2,77]), Night work ( p = 0.37; OR = 0.63 [0,23–1,71]), Age ( p = 0.54; OR = 1.27 [0,59–2,71]), Time spent in gold mining ( p = 0.15, OR = 1.75 [0,81–3,77]) and Hyperglycemia ( p = 0.31; OR = 1.29 [0,64–4,24]) did not show a statistically significant association with obesity. In multivariate analysis, we included: Sex, Time spent in gold mining, Gold panning (sensu stricto), Ottawa score, Hyperglycemia, HBP, Smoking tobacco status. The p -value was > 0.05 for each data point; we did not find any statistically significant association after multivariate analysis. Discussion Our study is the first to assess cardiovascular risk factors among illegal gold miners working on the French Guianese territory. This population constitutes a hidden and highly mobile group that is particularly difficult to reach through conventional epidemiological studies. Despite these challenges, our findings provide rare and original data highlighting a substantial burden of cardiovascular risk factors in this young and socially vulnerable population. The prevalence of cardiovascular risk was high: 2.1% of probable diabetes, 21% of HBP, 43% of overweight or obesity, 58% of excessive alcohol consumption and 39% of tobacco consumption. Without considering age, 89% of the study population had at least one cardiovascular risk factor. After multiple adjustments, HBP was associated with age, sex, time spent in gold mining, abdominal obesity and probable diabetes. In our study, obesity was not significantly associated with other risk factors. It would be interesting to conduct further studies focusing on this data, which is a common condition within our study population. Limitations This study has several limitations. First, a response rate could not be calculated, as refusals were not documented in this highly mobile and informal population, which may have introduced selection bias. Second, the cross‑sectional design and the absence of a sample size calculation for these specific outcomes limit causal inference and generalizability. Hypertension was assessed based on a single blood pressure measurement using a wrist device, which may have led to misclassification, although a repeat measurement after rest was performed in participants with elevated values. Blood glucose measurements were obtained under non‑fasting conditions, which may have resulted in an underestimation of diabetes prevalence despite the use of recommended threshold. Dyslipidaemia could not be assessed due to field constraints, preventing a comprehensive evaluation of cardiovascular risk. Finally, self‑reported substance use may have been subject to reporting bias. Low prevalence of probable diabetes despite a high burden of overweight Among the study population, 2.1% were classified as having probable diabetes. This prevalence is markedly lower than that reported in the general population of French Guiana in 2021 (9.3%) [ 34 ], where diabetes mainly affects women, middle-aged individuals, and those with a high BMI [ 35 ]. In Brazil, the country of origin of most participants, the prevalence of diabetes in the general population was 10.5% in 2021, although age-specific data were not available. Among other mining populations, a study conducted in 2017 in the Democratic Republic of Congo reported a diabetes prevalence of 11.7% [ 36 ]. This population was predominantly male (93%) with an average age of 37.8 years. Overall, our findings are therefore not consistent with previously reported data. However, we found 43% of participants with a BMI ≥ 25 kg/m2, including 36% overweight and 7% obese. In comparison, in 2019, Guiana had 51% of participants with a BMI ≥ 25 kg/m2 including 31.9% overweight and 19.1% with obesity [ 37 ]. In 2019, prevalence of BMI ≥ 25 kg/m2 in Brazil was 56.4% of which 35.6% overweight and 20.8% with obesity [ 34 ]. In Ghana, in 2015, 16.3% of gold miners were overweight or obese [ 35 ]. In Congo, in 2017, they were 24.7% [ 36 ]. These findings are unexpected given the physically demanding nature of gold-mining activities are physically demanding and require a high level of fitness. Several hypotheses may explain this apparent discrepancy. Limited access to a balanced diet may favor a diet rich in fats, leading to overweight but not to diabetes. Excessive alcohol consumption in our population may contribute to overweight and obesity. Possible explanatory mechanisms include exposure to environmental pollutants and heavy metals, particularly mercury, previously reported at elevated levels in similar populations, potentially affecting metabolic regulation and warranting future studies with biological exposure measurements [ 38 , 39 ]. Frequent self-medication with antibiotics could alter the intestinal microbiota and disrupt metabolism, leading to weight gain [ 40 ]. Chronic stress, linked to living and working conditions, may induce chronic hypercortisolemia, leading to overweight [ 41 ]. A high burden of high blood pressure Within the study population, 21.0% (95% CI: 15.7–25.9) of participants had a blood pressure ≥ 140/90 mmHg and were therefore strongly suspected of having hypertension. This prevalence is comparable to that reported in the general population of French Guiana in 2021 (22.7%) [ 42 ], where hypertension predominantly affects middle‑aged, overweight, and foreign women [ 43 ]. In Brazil, the prevalence of hypertension in the general population was estimated at 27.9% in 2023 [ 44 ], a slightly higher estimate, although direct comparisons should be interpreted with caution given differences in age structure and sex distribution. Higher prevalence estimates have been reported in populations more closely comparable to ours. A study conducted in 2015 among gold miners at the border between Suriname and French Guiana reported a hypertension prevalence of 37.1% (95% CI: 32.4–41.7), using a similar blood pressure measurement protocol. By contrast, studies conducted among gold‑mining populations in other settings have reported heterogeneous results, with prevalences ranging from 18.7% in the Democratic Republic of Congo in 2017 [ 36 ] and 19.5% in a gold‑mining community in Ghana in 2015 [ 45 ], to 39.5% among gold miners in South Africa between 2010 and 2012 [ 46 ]. These variations remain difficult to fully explain. However, regional differences in cardiovascular disease burden may partly contribute to this heterogeneity. In Brazil, cardiovascular morbidity varies substantially between states, with a higher burden reported in Maranhão compared with Amazonas, Amapá, or Roraima, states from which a considerable proportion of gold miners originate [ 47 ]. Beyond prevalence comparisons, our multivariate analysis showed a statistically significant association between high blood pressure and age, a well‑established finding that likely reflects age‑related arterial stiffening. We also observed an association between high blood pressure and duration of involvement in gold‑mining activities, independent of age in our model. This association may be related to cumulative occupational exposure to heavy metals, particularly mercury and lead, to which this population is known to be highly exposed [ 48 , 49 ]. While previous studies, including a 2018 meta‑analysis, have suggested a dose‑dependent association between blood mercury levels and arterial hypertension [ 50 ], the causal role of heavy‑metal exposure in the development of hypertension among gold miners remains to be clarified and warrants further investigation. A significant exposure to alcohol, tobacco and drugs Our study revealed a high prevalence of tobacco smoking (39%), markedly higher than that reported in the general population of French Guiana in 2024 (11.7%) [ 51 ] and in Brazil in 2019 (12.6%) [ 52 ]. Excessive alcohol consumption was also frequent, affecting 58% of participants. Data on excessive alcohol consumption in French Guiana are scarce; in 2020, 5.2% of the population reported daily alcohol consumption, although daily use does not necessarily indicate excessive intake. In Brazil, the Álcool e a Saúde dos Brasileiros – Panorama 2023 report estimated the prevalence of excessive alcohol consumption at 17%. Comparable high levels have been observed in other mining populations, such as coal mine workers in Australia in 2021, among whom 50.5% were classified as excessive drinkers [ 53 ]. Direct comparisons across studies remain difficult due to heterogeneous definitions of excessive alcohol consumption. Nevertheless, the high levels of alcohol and tobacco use observed in our study likely further compromise health, increasing the risk of liver disease, cancers, and respiratory disorders, particularly in a context of precarious working and living conditions. Such substance use may represent a coping strategy in response to the psychosocial stressors of mining sites, potentially leading to dependency, exacerbation of underlying mental health conditions, and engagement in risky behaviors (violence, accidents, injuries), thereby reinforcing a cycle of harmful consumption. A population at high risk of cardiovascular disease with limited access to care With 89% of participants having at least one cardiovascular risk factor, and 66% having two or more risk factors (excluding age), this population appears to be at particularly high cardiovascular risk. Age was not included in our calculations, as our objective was to focus on the accumulation of modifiable cardiovascular risk factors. Only one study conducted in 2006 in the general population of Santa Catarina State of Brazil showed that 52.4% of participants had no cardiovascular risk factors, 22.4% had a single risk factor and 25.2% had two or more risk factors [ 54 ]. That study included LDL cholesterol, which was not considered in our analysis; therefore, our estimates may be underestimated by comparison. In light of the “healthy immigrant effect” hypothesis [ 55 , 56 ], which suggests that individuals who migrate are generally younger and healthier than the population they leave behind, the high burden of cardiovascular risk factors observed in our study suggests that working and living conditions associated with illegal gold mining in French Guiana may substantially contribute to cardiovascular risk. Furthermore, access to care appeared limited: only half of participants with known diabetes or hypertension were receiving treatment at the time of inclusion, and none of the participants with known hypertension had blood pressure values below 140/90 mmHg. These findings are consistent with a previous survey in this population, which reported frequent interruptions of chronic treatment, affecting 26.6% of individuals among the 11.9% who reported being on long‑term treatment [ 15 ]. Conclusions Although informal gold miners in French Guiana are young and engaged in physically demanding work, this study shows for the first time that they are exposed to a high burden of cardiovascular risk factors and toxic exposures, highlighting their particular vulnerability. Limited access to medical care further exacerbates this vulnerability. These findings underscore the urgent need to implement adapted health-promotion and prevention interventions aimed at improving awareness of cardiovascular risk factors and diseases, facilitating access to healthcare services, and ultimately contributing to the reduction of health inequalities in this highly marginalized population. Acknowledgements The authors thanks all the participants to this survey and the field team: Alan Ribeiro, Mylène Cébé and Audrey Godin. Authors’ contributions MD, MG, YL, LHM and SV conceived the study. MD, MG and SV wrote the protocol. MD, MG, YL, LHM, AA, MN and SV implemented the study. GAT performed the analysis, MD verified the underlying data. GAT wrote the first draft. All authors read and approved the final manuscript. The authors confirm they had full access to the data in the study and accept responsibility to submit for publication. Funding The study was fudned by the European Regional Devel-opment Fund (FEDER) via the Interregional Amazon Cooperation Program (IACP) 2014–2020 (N °Presage 3949), supplemented with self-funding from the CHC and funds from the French Guiana Regional Health Agency. The funding bodies have no role in the implementation and analysis of the project. Data availability Data can be available under the request to the corresponding author. Declarations Ethics approval and consent to participate In Suriname, ethical approval was obtained from the Commission for Medical Scientific Research in Suriname (CMWO), Ministry of Health of Suriname (Opinion Number DVG-738). The trial has been registered with ClinicalTrials.gov (Registration numberNCT03695770). The database was anonymized and registered in accordance with the European General Data Protection Regulation (GDPR). This study was conducted in accordance with the principles of the Declaration of Helsinki. Participants had given their consent prior to taking part in the study. All patients gave their written informed consent. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Footnotes Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. References 1. 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