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Wealth and Cardiovascular Health: A Cross-Sectional Study of Wealth-Related Inequalities in the Awareness, Treatment and Control of Hypertension in High-, Middle- and Low-Income Countries Publisher Pubmed



Palafox B1 ; Mckee M1 ; Balabanova D1 ; Alhabib KF2 ; Bahonar A4 ; Ismail N5 ; Chifamba J6 ; Chow CK7 ; Corsi DJ8 ; Dagenais GR9 ; Diaz R10 ; Gupta R11 ; Iqbal R12 ; Kaur M13 Show All Authors
Authors
  1. Palafox B1
  2. Mckee M1
  3. Balabanova D1
  4. Alhabib KF2
  5. Bahonar A4
  6. Ismail N5
  7. Chifamba J6
  8. Chow CK7
  9. Corsi DJ8
  10. Dagenais GR9
  11. Diaz R10
  12. Gupta R11
  13. Iqbal R12
  14. Kaur M13
  15. Khatib R14
  16. Kruger A15
  17. Kruger IM16
  18. Lanas F17
  19. Lopezjaramillo P18
  20. Minfan F20
  21. Mohan V21
  22. Mony PK22
  23. Oguz A23
  24. Palileovillanueva LM24
  25. Perel P25, 26
  26. Poirier P27
  27. Rangarajan S28
  28. Rensheng L29
  29. Rosengren A30
  30. Soman B31
  31. Stuckler D32
  32. Subramanian SV33
  33. Teo K14
  34. Tsolekile LP34
  35. Wielgosz A35
  36. Yaguang P36
  37. Yeates K37
  38. Yongzhen M38
  39. Yusoff K39, 40
  40. Yusuf R41
  41. Yusufali A42
  42. Zatonska K43
  43. Yusuf S14
Show Affiliations
Authors Affiliations
  1. 1. ECOHOST-The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom
  2. 2. Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
  3. 3. Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
  4. 4. Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
  5. 5. Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
  6. 6. Physiology Department, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
  7. 7. George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
  8. 8. Ottawa Hospital Research Institute, Ottawa, Canada
  9. 9. Quebec Heart and Lung University Institute, Quebec City, QC, Canada
  10. 10. Estudios Clinicos Latinoamerica, Rosario, Santa Fe, Argentina
  11. 11. Eternal Heart Care Centre and Research Institute, Jaipur, Rajasthan, India
  12. 12. Departments of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
  13. 13. School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  14. 14. Population Health Research Institute, McMaster University, Hamilton, ON, Canada
  15. 15. Africa Unit for Transdisciplinary Health Research, Medical Research Council Research Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
  16. 16. Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
  17. 17. Universidad de la Frontera, Temuco, Chile
  18. 18. Research Institute, Fundacion Oftalmologica de Santander
  19. 19. and Medical School, University of Santander, Floridablanca, Bucaramanga, Colombia
  20. 20. Daxing Health Center, Shenyang City, Liaoning Province, China
  21. 21. Madras Diabetes Research Foundation, Chennai, India
  22. 22. St John's Medical College and Research Institute, Bangalore, India
  23. 23. Department of Internal Medicine, Istanbul Medeniyet University, Istanbul, Turkiye
  24. 24. College of Medicine, University of the Philippines Manila, Manila, Philippines
  25. 25. World Heart Federation, Geneva, Switzerland
  26. 26. London School of Hygiene and Tropical Medicine, London, United Kingdom
  27. 27. Faculte de Pharmacie, Universite Laval Institut, Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada
  28. 28. Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
  29. 29. Center for Disease Control and Prevention, Nanchang City, Jiangxi Province, China
  30. 30. Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital, Ostra Hospital, Goteborg, Sweden
  31. 31. Health Action by People, Thiruvananthapuram, Achutha Menon Centre for Health Science Studies, Sree Chitra Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
  32. 32. Department of Sociology, University of Oxford, Oxford, United Kingdom
  33. 33. Department of Social and Behavioral Sciences, Harvard University, Boston, MA, United States
  34. 34. University of the Western Cape, Bellville, Western Province, South Africa
  35. 35. Ottawa Hospital, Ottawa, ON, Canada
  36. 36. Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, FuWai Hospital, Beijing, China
  37. 37. Department of Medicine, Queen's University, Kingston, Canada
  38. 38. Institute of Geriatrics, Nanjing City, Jiangsu Province, China
  39. 39. UCSI University, Kuala Lumpur, Malaysia
  40. 40. Universiti Teknologi MARA, Selayang, Selangor, Malaysia
  41. 41. Independent University, Dhaka, Bangladesh
  42. 42. Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates
  43. 43. Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland

Source: International Journal for Equity in Health Published:2016


Abstract

Background: Effective policies to control hypertension require an understanding of its distribution in the population and the barriers people face along the pathway from detection through to treatment and control. One key factor is household wealth, which may enable or limit a household's ability to access health care services and adequately control such a chronic condition. This study aims to describe the scale and patterns of wealth-related inequalities in the awareness, treatment and control of hypertension in 21 countries using baseline data from the Prospective Urban and Rural Epidemiology study. Methods: A cross-section of 163,397 adults aged 35 to 70 years were recruited from 661 urban and rural communities in selected low-, middle- and high-income countries (complete data for this analysis from 151,619 participants). Using blood pressure measurements, self-reported health and household data, concentration indices adjusted for age, sex and urban-rural location, we estimate the magnitude of wealth-related inequalities in the levels of hypertension awareness, treatment, and control in each of the 21 country samples. Results: Overall, the magnitude of wealth-related inequalities in hypertension awareness, treatment, and control was observed to be higher in poorer than in richer countries. In poorer countries, levels of hypertension awareness and treatment tended to be higher among wealthier households; while a similar pro-rich distribution was observed for hypertension control in countries at all levels of economic development. In some countries, hypertension awareness was greater among the poor (Sweden, Argentina, Poland), as was treatment (Sweden, Poland) and control (Sweden). Conclusion: Inequality in hypertension management outcomes decreased as countries became richer, but the considerable variation in patterns of wealth-related inequality - even among countries at similar levels of economic development - underscores the importance of health systems in improving hypertension management for all. These findings show that some, but not all, countries, including those with limited resources, have been able to achieve more equitable management of hypertension; and strategies must be tailored to national contexts to achieve optimal impact at population level. © 2016 The Author(s).
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