Hypertension care cascades and reducing inequities in cardiovascular disease in low- and middle-income countries.

Autor: Stein DT; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA., Reitsma MB; Department of Health Policy, Stanford School of Medicine, Stanford University, Stanford, CA, USA., Geldsetzer P; Division of Primary Care and Population Health, Stanford University, Stanford, CA, USA.; Chan Zuckerberg Biohub, San Francisco, CA, USA., Agoudavi K; Noncommunicable Disease Program, Ministry of Health, Lomé, Togo., Aryal KK; Bergen Centre for Ethics and Priority Setting in Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.; Public Health Promotion and Development Organization, Kathmandu, Nepal., Bahendeka S; MKPGMS-Uganda Martyrs University, Kampala, Uganda.; St. Francis Hospital, Nsambya, Kampala, Uganda., Brant LCC; Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil., Farzadfar F; Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran., Gurung MS; Policy and Planning Division, Ministry of Health, Thimphu, Bhutan., Guwatudde D; Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda., Houehanou YCN; National School of Public Health, University of Parakou, Parakou, Benin., Malta DC; Department Maternal Child and Public Health, Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil., Martins JS; Faculty of Medicine and Health Sciences, Universidade Nacional Timor Lorosa'e, Díli, Timor-Leste., Saeedi Moghaddam S; 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., Mwangi KJ; World Health Organization, Pretoria, South Africa.; Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya., Norov B; Nutrition Department, National Center for Public Health, Ulaanbaatar, Mongolia., Sturua L; National Center for Disease Control and Public Health, Tbilisi, Georgia.; Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia., Zhumadilov Z; School of Medicine, Nazarbayev University, Astana, Kazakhstan., 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., Davies JI; Institute of Applied Health Research, University of Birmingham, Birmingham, UK.; Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa., Flood D; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.; Center for Indigenous Health Research, Wuqu' Kawoq, Tecpán, Guatemala., Marcus ME; 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.; Professorship of Behavioral Science for Disease Prevention and Health Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany., Vollmer S; Department of Economics & Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany., Manne-Goehler J; Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA.; Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA., Atun R; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA., Sudharsanan N; Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany.; Professorship of Behavioral Science for Disease Prevention and Health Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany., Verguet S; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA. verguet@hsph.harvard.edu.
Jazyk: angličtina
Zdroj: Nature medicine [Nat Med] 2024 Feb; Vol. 30 (2), pp. 414-423. Date of Electronic Publication: 2024 Jan 26.
DOI: 10.1038/s41591-023-02769-8
Abstrakt: Improving hypertension control in low- and middle-income countries has uncertain implications across socioeconomic groups. In this study, we simulated improvements in the hypertension care cascade and evaluated the distributional benefits across wealth quintiles in 44 low- and middle-income countries using individual-level data from nationally representative, cross-sectional surveys. We raised diagnosis (diagnosis scenario) and treatment (treatment scenario) levels for all wealth quintiles to match the best-performing country quintile and estimated the change in 10-year cardiovascular disease (CVD) risk of individuals initiated on treatment. We observed greater health benefits among bottom wealth quintiles in middle-income countries and in countries with larger baseline disparities in hypertension management. Lower-middle-income countries would see the greatest absolute benefits among the bottom quintiles under the treatment scenario (29.1 CVD cases averted per 1,000 people living with hypertension in the bottom quintile (Q1) versus 17.2 in the top quintile (Q5)), and the proportion of total CVD cases averted would be largest among the lowest quintiles in upper-middle-income countries under both diagnosis (32.0% of averted cases in Q1 versus 11.9% in Q5) and treatment (29.7% of averted cases in Q1 versus 14.0% in Q5) scenarios. Targeted improvements in hypertension diagnosis and treatment could substantially reduce socioeconomic-based inequalities in CVD burden in low- and middle-income countries.
(© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)
Databáze: MEDLINE
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