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

Benjamin Palafox, Martin McKee, Dina Balabanova, Khalid F. Alhabib, Alvaro Avezum, Ahmad Bahonar, Noor Hassim Ismail, Jephat Chifamba, Clara K. Chow, Daniel J. Corsi, Gilles R. Dagenais, Rafael Diaz, Rajeev Gupta, Romaina Iqbal, Manmeet Kaur, Rasha Khatib, Annamarie Kruger, Iolanthe Marike Kruger, Fernando Lanas, Patricio Lopez-Jaramillo & 24 others Fu Minfan, Viswanathan Mohan, Prem K. Mony, Aytekin Oguz, Lia M. Palileo-Villanueva, Pablo Perel, Paul Poirier, Sumathy Rangarajan, Lei Rensheng, Annika Rosengren, Biju Soman, David Stuckler, S. V. Subramanian, Koon Teo, Lungiswa P. Tsolekile, Andreas Wielgosz, Peng Yaguang, Karen Yeates, Mo Yongzhen, Khalid Yusoff, Rita Yusuf, Afzalhussein Yusufali, Katarzyna Zatońska, Salim Yusuf

Research output: Contribution to journalArticle

12 Citations (Scopus)

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.

Original languageEnglish
Article number199
JournalInternational Journal for Equity in Health
Volume15
Issue number1
DOIs
Publication statusPublished - 8 Dec 2016

Fingerprint

Cross-Sectional Studies
Hypertension
Health
Sweden
Therapeutics
Economic Development
Poland
Aptitude
Argentina
Rural Population
Health Services
Epidemiology
Demography
Blood Pressure
Population

Keywords

  • Global health
  • Healthcare disparities
  • Hypertension
  • Socioeconomic factors

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

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. / Palafox, Benjamin; McKee, Martin; Balabanova, Dina; Alhabib, Khalid F.; Avezum, Alvaro; Bahonar, Ahmad; Ismail, Noor Hassim; Chifamba, Jephat; Chow, Clara K.; Corsi, Daniel J.; Dagenais, Gilles R.; Diaz, Rafael; Gupta, Rajeev; Iqbal, Romaina; Kaur, Manmeet; Khatib, Rasha; Kruger, Annamarie; Kruger, Iolanthe Marike; Lanas, Fernando; Lopez-Jaramillo, Patricio; Minfan, Fu; Mohan, Viswanathan; Mony, Prem K.; Oguz, Aytekin; Palileo-Villanueva, Lia M.; Perel, Pablo; Poirier, Paul; Rangarajan, Sumathy; Rensheng, Lei; Rosengren, Annika; Soman, Biju; Stuckler, David; Subramanian, S. V.; Teo, Koon; Tsolekile, Lungiswa P.; Wielgosz, Andreas; Yaguang, Peng; Yeates, Karen; Yongzhen, Mo; Yusoff, Khalid; Yusuf, Rita; Yusufali, Afzalhussein; Zatońska, Katarzyna; Yusuf, Salim.

In: International Journal for Equity in Health, Vol. 15, No. 1, 199, 08.12.2016.

Research output: Contribution to journalArticle

Palafox, B, McKee, M, Balabanova, D, Alhabib, KF, Avezum, A, Bahonar, A, Ismail, NH, Chifamba, J, Chow, CK, Corsi, DJ, Dagenais, GR, Diaz, R, Gupta, R, Iqbal, R, Kaur, M, Khatib, R, Kruger, A, Kruger, IM, Lanas, F, Lopez-Jaramillo, P, Minfan, F, Mohan, V, Mony, PK, Oguz, A, Palileo-Villanueva, LM, Perel, P, Poirier, P, Rangarajan, S, Rensheng, L, Rosengren, A, Soman, B, Stuckler, D, Subramanian, SV, Teo, K, Tsolekile, LP, Wielgosz, A, Yaguang, P, Yeates, K, Yongzhen, M, Yusoff, K, Yusuf, R, Yusufali, A, Zatońska, K & Yusuf, S 2016, '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', International Journal for Equity in Health, vol. 15, no. 1, 199. https://doi.org/10.1186/s12939-016-0478-6
Palafox, Benjamin ; McKee, Martin ; Balabanova, Dina ; Alhabib, Khalid F. ; Avezum, Alvaro ; Bahonar, Ahmad ; Ismail, Noor Hassim ; Chifamba, Jephat ; Chow, Clara K. ; Corsi, Daniel J. ; Dagenais, Gilles R. ; Diaz, Rafael ; Gupta, Rajeev ; Iqbal, Romaina ; Kaur, Manmeet ; Khatib, Rasha ; Kruger, Annamarie ; Kruger, Iolanthe Marike ; Lanas, Fernando ; Lopez-Jaramillo, Patricio ; Minfan, Fu ; Mohan, Viswanathan ; Mony, Prem K. ; Oguz, Aytekin ; Palileo-Villanueva, Lia M. ; Perel, Pablo ; Poirier, Paul ; Rangarajan, Sumathy ; Rensheng, Lei ; Rosengren, Annika ; Soman, Biju ; Stuckler, David ; Subramanian, S. V. ; Teo, Koon ; Tsolekile, Lungiswa P. ; Wielgosz, Andreas ; Yaguang, Peng ; Yeates, Karen ; Yongzhen, Mo ; Yusoff, Khalid ; Yusuf, Rita ; Yusufali, Afzalhussein ; Zatońska, Katarzyna ; Yusuf, Salim. / 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. In: International Journal for Equity in Health. 2016 ; Vol. 15, No. 1.
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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.",
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TY - JOUR

T1 - Wealth and cardiovascular health

T2 - A cross-sectional study of wealth-related inequalities in the awareness, treatment and control of hypertension in high-, middle- and low-income countries

AU - Palafox, Benjamin

AU - McKee, Martin

AU - Balabanova, Dina

AU - Alhabib, Khalid F.

AU - Avezum, Alvaro

AU - Bahonar, Ahmad

AU - Ismail, Noor Hassim

AU - Chifamba, Jephat

AU - Chow, Clara K.

AU - Corsi, Daniel J.

AU - Dagenais, Gilles R.

AU - Diaz, Rafael

AU - Gupta, Rajeev

AU - Iqbal, Romaina

AU - Kaur, Manmeet

AU - Khatib, Rasha

AU - Kruger, Annamarie

AU - Kruger, Iolanthe Marike

AU - Lanas, Fernando

AU - Lopez-Jaramillo, Patricio

AU - Minfan, Fu

AU - Mohan, Viswanathan

AU - Mony, Prem K.

AU - Oguz, Aytekin

AU - Palileo-Villanueva, Lia M.

AU - Perel, Pablo

AU - Poirier, Paul

AU - Rangarajan, Sumathy

AU - Rensheng, Lei

AU - Rosengren, Annika

AU - Soman, Biju

AU - Stuckler, David

AU - Subramanian, S. V.

AU - Teo, Koon

AU - Tsolekile, Lungiswa P.

AU - Wielgosz, Andreas

AU - Yaguang, Peng

AU - Yeates, Karen

AU - Yongzhen, Mo

AU - Yusoff, Khalid

AU - Yusuf, Rita

AU - Yusufali, Afzalhussein

AU - Zatońska, Katarzyna

AU - Yusuf, Salim

PY - 2016/12/8

Y1 - 2016/12/8

N2 - 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.

AB - 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.

KW - Global health

KW - Healthcare disparities

KW - Hypertension

KW - Socioeconomic factors

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