Diagnostic testing for hypertension, diabetes, and hypercholesterolaemia in low-income and middle-income countries: a cross-sectional study of data for 994 185 individuals from 57 nationally representative surveys.

Autor:	Ochmann S; Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Goettingen, Germany., von Polenz I; Faculty of Medicine, University of Goettingen, Goettingen, Germany., Marcus ME; Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA., Theilmann M; Heidelberg Institute of Global Health, Faculty of Medicine, and University Hospital, Heidelberg University, Heidelberg, Germany., Flood D; University of Michigan, Ann Arbor, MI, USA., Agoudavi K; Togo Ministry of Health, Lome, Togo., Aryal KK; Bergen Center for Ethics and Priority Setting, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway., Bahendeka S; Saint Francis Hospital Nsambya, Uganda Martyrs University, Kampala, Uganda., Bicaba B; Institut National de Santé Publique, Ouagadougou, Burkina Faso., Bovet P; Ministry of Health, Victoria, Seychelles; University Center for General Medicine and Public Health (Unisanté), Lausanne, Switzerland., Campos Caldeira Brant L; Department of Clinical Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil., Carvalho Malta D; Postgraduate Program in Public Health, Federal University of Minas Gerais, Belo Horizonte, Brazil., Damasceno A; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique., Farzadfar F; Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran., Gathecha G; Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya., Ghanbari A; Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran., Gurung M; Health Research and Epidemiology Unit, Ministry of Health, Thimphu, Bhutan., Guwatudde D; Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda., Houehanou C; Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin., Houinato D; Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin., Hwalla N; Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon., Jorgensen JA; Global Health Section, Dept of Public Health, University of Copenhagen, Cophenhagen, Denmark., Karki KB; Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal., Lunet N; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional, Porto, Portugal., Martins J; Faculty of Medicine and Health Sciences, Universidade Nacional Timor Lorosa'e, Dili, Timor-Leste., Mayige M; National Institute for Medical Research, Dar es Salaam, Tanzania., Moghaddam SS; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Kiel Institute for the World Economy, Kiel, Germany., Mwalim O; Bergen Center for Ethics and Priority Setting, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway; Ministry of Health, Zanzibar City, Tanzania., Mwangi KJ; Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya; Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland., Norov B; Nutrition Division, National Center for Public Health, Ulaanbaatar, Mongolia., Quesnel-Crooks S; Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago., Rezaei N; Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran., Sibai AM; Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon., Sturua L; Non-Communicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia., Tsabedze L; Ministry of Health, Mbabane, Eswatini., Wong-McClure R; Office of Epidemiology and Surveillance, Caja Costarricense de Seguro Social, San José, Costa Rica., Davies J; Institute of Applied Health Research, University of Birmingham, Birmingham, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa., Geldsetzer P; Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA; Chan Zuckerberg Biohub, San Francisco, CA, USA., Bärnighausen T; Heidelberg Institute of Global Health, Faculty of Medicine, and University Hospital, Heidelberg University, Heidelberg, Germany; Harvard Center for Population and Development Studies, Cambridge, MA, USA; Africa Health Research Institute, KwaZulu-Natal, South Africa., Atun R; Department of Global Health and Social Medicine, Boston, MA, USA; Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA., Manne-Goehler J; Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA., Vollmer S; Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Goettingen, Germany. Electronic address: sebastian.vollmer@wiwi.uni-goettingen.de.
Jazyk:	angličtina
Zdroj:	The Lancet. Global health [Lancet Glob Health] 2023 Sep; Vol. 11 (9), pp. e1363-e1371.
DOI:	10.1016/S2214-109X(23)00280-2
Abstrakt:	Background: Testing for the risk factors of cardiovascular disease, which include hypertension, diabetes, and hypercholesterolaemia, is important for timely and effective risk management. Yet few studies have quantified and analysed testing of cardiovascular risk factors in low-income and middle-income countries (LMICs) with respect to sociodemographic inequalities. We aimed to address this knowledge gap. Methods: In this cross-sectional analysis, we pooled individual-level data for non-pregnant adults aged 18 years or older from nationally representative surveys done between Jan 1, 2010, and Dec 31, 2019 in LMICs that included a question about whether respondents had ever had their blood pressure, glucose, or cholesterol measured. We analysed diagnostic testing performance by quantifying the overall proportion of people who had ever been tested for these cardiovascular risk factors and the proportion of individuals who met the diagnostic testing criteria in the WHO package of essential noncommunicable disease interventions for primary care (PEN) guidelines (ie, a BMI >30 kg/m 2 or a BMI >25 kg/m 2 among people aged 40 years or older). We disaggregated and compared diagnostic testing performance by sex, wealth quintile, and education using two-sided t tests and multivariable logistic regression models. Findings: Our sample included data for 994 185 people from 57 surveys. 19·1% (95% CI 18·5-19·8) of the 943 259 people in the hypertension sample met the WHO PEN criteria for diagnostic testing, of whom 78·6% (77·8-79·2) were tested. 23·8% (23·4-24·3) of the 225 707 people in the diabetes sample met the WHO PEN criteria for diagnostic testing, of whom 44·9% (43·7-46·2) were tested. Finally, 27·4% (26·3-28·6) of the 250 573 people in the hypercholesterolaemia sample met the WHO PEN criteria for diagnostic testing, of whom 39·7% (37·1-2·4) were tested. Women were more likely than men to be tested for hypertension and diabetes, and people in higher wealth quintiles compared with those in the lowest wealth quintile were more likely to be tested for all three risk factors, as were people with at least secondary education compared with those with less than primary education. Interpretation: Our study shows opportunities for health systems in LMICs to improve the targeting of diagnostic testing for cardiovascular risk factors and adherence to diagnostic testing guidelines. Risk-factor-based testing recommendations rather than sociodemographic characteristics should determine which individuals are tested. Funding: Harvard McLennan Family Fund, the Alexander von Humboldt Foundation, and the National Heart, Lung, and Blood Institute of the US National Institutes of Health. Competing Interests: Declaration of interests We declare no competing interests. (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)
Databáze:	MEDLINE
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