Abstract
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.
| Original language | English |
|---|---|
| Number of pages | 21 |
| Journal | Nature Medicine |
| Early online date | 26 Jan 2024 |
| DOIs | |
| Publication status | E-pub ahead of print - 26 Jan 2024 |
Bibliographical note
Acknowledgments:D.T.S. and S.V. acknowledge funding from the Trond Mohn Foundation and NORAD through Bergen Center for Ethics and Priority Setting (project no. 813596). L.C.C.B. is partly supported by the Brazilian National Research Agency (CNPq grant 307329/2022-4). The study sponsor had no role in the collection, analysis, interpretation of data, writing of the report or decision to submit the manuscript for publication. Earlier versions of this manuscript were presented during seminars at Harvard University as well as during the 2022 Global Symposium for Health Systems Research in Bogotá, Colombia. At these occasions and others, we received valuable comments from participants, including A. Pandya, G. Danaei, C. Boyer and D. Cutler. Statistical support was provided by N. Greifer at the Institute for Quantitative Social Science at Harvard University. We thank three reviewers for valuable and constructive comments.
