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Multiple Cardiovascular Risk Factor Care in 55 Low- and Middle-Income Countries: A Cross-Sectional Analysis of Nationally-Representative, Individual-Level Data From 280,783 Adults Publisher



Diallo AO1 ; Marcus ME2 ; Flood D3 ; Theilmann M4 ; Rahim NE5 ; Kinlaw A6, 7 ; Franceschini N1 ; Sturmer T1 ; Tien DV5 ; Abbasikangevari M8 ; Agoudavi K9 ; Andallbrereton G10 ; Aryal K11 ; Bahendeka S12 Show All Authors
Authors
  1. Diallo AO1
  2. Marcus ME2
  3. Flood D3
  4. Theilmann M4
  5. Rahim NE5
  6. Kinlaw A6, 7
  7. Franceschini N1
  8. Sturmer T1
  9. Tien DV5
  10. Abbasikangevari M8
  11. Agoudavi K9
  12. Andallbrereton G10
  13. Aryal K11
  14. Bahendeka S12
  15. Bicaba B13
  16. Bovet P14, 15
  17. Dorobantu M16
  18. Farzadfar F8
  19. Ghamari SH8
  20. Gathecha G17
  21. Guwatudde D18
  22. Gurung M19
  23. Houehanou C20
  24. Houinato D20
  25. Hwalla N21
  26. Jorgensen J22
  27. Kagaruki G23
  28. Karki K24
  29. Martins J25
  30. Mayige M23
  31. Mcclure RW26
  32. Moghaddam SS27
  33. Mwalim O28
  34. Mwangi KJ17
  35. Norov B29
  36. Quesnelcrooks S10
  37. Sibai A30
  38. Sturua L31
  39. Tsabedze L32
  40. Wesseh C33
  41. Geldsetzer P4, 34
  42. Atun R35, 36
  43. Vollmer S2
  44. Barnighausen T4, 35, 37
  45. Davies J38, 39, 40
  46. Ali MK41
  47. Seiglie JA42
  48. Gower EW1, 43
  49. Mannegoehler J2, 44
Show Affiliations
Authors Affiliations
  1. 1. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
  2. 2. Department of Economics, Centre for Modern Indian Studies, University of Goettingen, Gottingen, Germany
  3. 3. University of Michigan, Ann Arbor, MI, United States
  4. 4. Faculty of Medicine, University Hospital, Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
  5. 5. Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
  6. 6. Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina School of Pharmacy at Chapel Hill, Chapel Hill, NC, United States
  7. 7. Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
  8. 8. Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
  9. 9. Togo Ministry of Health, Lome, Togo
  10. 10. Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago
  11. 11. Nepal Health Sector Programme 3, Monitoring Evaluation and Operational Research Project, Abt Associates, Kathmandu, Nepal
  12. 12. Saint Francis Hospital Nsambya, Kampala, Uganda
  13. 13. Institut Africain de Sante Publique, Ouagadougou, Burkina Faso
  14. 14. Ministry of Health, Victoria, Seychelles
  15. 15. University Center for Primary Care and Public Health (Unisante), Lausanne, Switzerland
  16. 16. Department of Cardiology, Emergency Hospital of Bucharest, Bucharest, Romania
  17. 17. Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
  18. 18. Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
  19. 19. Health Research and Epidemiology Unit, Ministry of Health, Thimphu, Bhutan
  20. 20. Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
  21. 21. Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
  22. 22. Dept of Public Health and Epidemiology, Institute of Global Health, Copenhagen University, Copenhagen, Denmark
  23. 23. National Institute for Medical Research, Dar es Salaam, Tanzania
  24. 24. Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
  25. 25. Faculty of Medicine and Health Sciences, Universidade Nacional Timor Lorosa’e, Dili, Timor-Leste
  26. 26. Office of Epidemiology and Surveillance, Costa Rican Social Security Fund, San Jose, Costa Rica
  27. 27. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
  28. 28. Ministry of Health, Zanzibar City, Tanzania
  29. 29. Nutrition Department, National Center for Public Health, Ulaanbaatar, Mongolia
  30. 30. Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
  31. 31. Non-Communicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia
  32. 32. Ministry of Health, Mbabane, Swaziland
  33. 33. Ministry of Health, Monrovia, Liberia
  34. 34. Division of Primary Care and Population Health, Stanford University, Stanford, CA, United States
  35. 35. Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
  36. 36. Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, United States
  37. 37. Africa Health Research Institute, Somkhele, South Africa
  38. 38. MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
  39. 39. Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
  40. 40. Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
  41. 41. Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
  42. 42. Diabetes Unit, Massachusetts General Hospital, Boston, MA, United States
  43. 43. Department of Ophthalmology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
  44. 44. Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States

Source: PLOS Global Public Health Published:2024


Abstract

The prevalence of multiple age-related cardiovascular disease (CVD) risk factors is high among individuals living in low- and middle-income countries. We described receipt of healthcare services for and management of hypertension and diabetes among individuals living with these conditions using individual-level data from 55 nationally representative population-based surveys (2009–2019) with measured blood pressure (BP) and diabetes biomarker. We restricted our analysis to non-pregnant individuals aged 40–69 years and defined three mutually exclusive groups (i.e., hypertension only, diabetes only, and both hypertension-diabetes) to compare individuals living with concurrent hypertension and diabetes to individuals with each condition separately. We included 90,086 individuals who lived with hypertension only, 11,975 with diabetes only, and 16,228 with hypertension-diabetes. We estimated the percentage of individuals who were aware of their diagnosis, used pharmacological therapy, or achieved appropriate hypertension and diabetes management. A greater percentage of individuals with hypertension-diabetes were fully diagnosed (64.1% [95% CI: 61.8–66.4]) than those with hypertension only (47.4% [45.3–49.6]) or diabetes only (46.7% [44.1–49.2]). Among the hypertension-diabetes group, pharmacological treatment was higher for individual conditions (38.3% [95% CI: 34.8–41.8] using antihypertensive and 42.3% [95% CI: 39.4–45.2] using glucose-lowering medications) than for both conditions jointly (24.6% [95% CI: 22.1–27.2]).The percentage of individuals achieving appropriate management was highest in the hypertension group (17.6% [16.4–18.8]), followed by diabetes (13.3% [10.7–15.8]) and hypertension-diabetes (6.6% [5.4–7.8]) groups. Although health systems in LMICs are reaching a larger share of individuals living with both hypertension and diabetes than those living with just one of these conditions, only seven percent achieved both BP and blood glucose treatment targets. Implementation of cost-effective population-level interventions that shift clinical care paradigm from disease-specific to comprehensive CVD care are urgently needed for all three groups, especially for those with multiple CVD risk factors. © 2024 Diallo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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