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

Alpha Oumar  Diallo; Maja E. Marcus; David  Flood; Michaela Theilmann; Nicholas E. Rahim; Alan Kinlaw; Nora Franceschini; Til Stürmer; Dessie V.  Tien; Mohsen  Abbasi-Kangevari; Kokou Agoudavi; Glennis Andall-Brereton; Krishna  Aryal; Silver Bahendeka; Bicaba Brice; Pascal Bovet; Maria Dorobantu; Farshad Farzadfar; Seyyed-Hadi  Ghamari; Gladwell Gathecha; David Guwatudde; Mongal  Gurung; Corine Houehanou; Dismand Houinato; Nahla Hwalla; Jutta Jorgensen; Gibson  Kagaruki; Khem Karki; Joao  Martins; Mary Mayige; Roy Wong McClure; Sahar Saeedi Moghaddam; Omar Mwalim; Joseph Kibachio Mwangi; Bolormaa Norov; Sarah Quesnel-Crooks; Abla Sibai; Lela Sturua; Lindiwe Tsabedze; Chea  Wesseh; Pascal Geldsetzer; Rifat Atun; Sebastian Vollmer; Till Bärnighausen; Justine Davies; Mohammed K Ali; Jacqueline A.  Seiglie; Emily W.  Gower; Jennifer Manne-Goehler

doi:10.1371/journal.pgph.0003019

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

Alpha Oumar Diallo, Maja E. Marcus, David Flood, Michaela Theilmann, Nicholas E. Rahim, Alan Kinlaw, Nora Franceschini, Til Stürmer, Dessie V. Tien, Mohsen Abbasi-Kangevari, Kokou Agoudavi, Glennis Andall-Brereton, Krishna Aryal, Silver Bahendeka, Bicaba Brice, Pascal Bovet, Maria Dorobantu, Farshad Farzadfar, Seyyed-Hadi Ghamari, Gladwell GathechaDavid Guwatudde, Mongal Gurung, Corine Houehanou, Dismand Houinato, Nahla Hwalla, Jutta Jorgensen, Gibson Kagaruki, Khem Karki, Joao Martins, Mary Mayige, Roy Wong McClure, Sahar Saeedi Moghaddam, Omar Mwalim, Joseph Kibachio Mwangi, Bolormaa Norov, Sarah Quesnel-Crooks, Abla Sibai, Lela Sturua, Lindiwe Tsabedze, Chea Wesseh, Pascal Geldsetzer, Rifat Atun, Sebastian Vollmer, Till Bärnighausen, Justine Davies, Mohammed K Ali, Jacqueline A. Seiglie , Emily W. Gower^*, Jennifer Manne-Goehler

^*Corresponding author for this work

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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.

Original language	English
Article number	e0003019
Number of pages	17
Journal	PLOS Global Public Health
Volume	4
Issue number	3
DOIs	https://doi.org/10.1371/journal.pgph.0003019
Publication status	Published - 27 Mar 2024

Bibliographical note

Funding:
Harvard T H Chan School of Public Health McLennan Fund: Dean's Challenge Grant Program and the EU's Research and Innovation programme Horizon 2020. There are no grant numbers. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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This output contributes to the following UN Sustainable Development Goals (SDGs)

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Diallo, A. O., Marcus, M. E., Flood, D., Theilmann, M., Rahim, N. E., Kinlaw, A., Franceschini, N., Stürmer, T., Tien, D. V., Abbasi-Kangevari, M., Agoudavi, K., Andall-Brereton, G., Aryal, K., Bahendeka, S., Brice, B., Bovet, P., Dorobantu, M., Farzadfar, F., Ghamari, S.-H., ... Manne-Goehler, J. (2024). 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. PLOS Global Public Health, 4(3), Article e0003019. https://doi.org/10.1371/journal.pgph.0003019

@article{bc18d35c968b46ec99e435bb0627cae0,

title = "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",

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.",

author = "Diallo, {Alpha Oumar} and Marcus, {Maja E.} and David Flood and Michaela Theilmann and Rahim, {Nicholas E.} and Alan Kinlaw and Nora Franceschini and Til St{\"u}rmer and Tien, {Dessie V.} and Mohsen Abbasi-Kangevari and Kokou Agoudavi and Glennis Andall-Brereton and Krishna Aryal and Silver Bahendeka and Bicaba Brice and Pascal Bovet and Maria Dorobantu and Farshad Farzadfar and Seyyed-Hadi Ghamari and Gladwell Gathecha and David Guwatudde and Mongal Gurung and Corine Houehanou and Dismand Houinato and Nahla Hwalla and Jutta Jorgensen and Gibson Kagaruki and Khem Karki and Joao Martins and Mary Mayige and McClure, {Roy Wong} and Moghaddam, {Sahar Saeedi} and Omar Mwalim and Mwangi, {Joseph Kibachio} and Bolormaa Norov and Sarah Quesnel-Crooks and Abla Sibai and Lela Sturua and Lindiwe Tsabedze and Chea Wesseh and Pascal Geldsetzer and Rifat Atun and Sebastian Vollmer and Till B{\"a}rnighausen and Justine Davies and Ali, {Mohammed K} and Seiglie, {Jacqueline A.} and Gower, {Emily W.} and Jennifer Manne-Goehler",

note = "Funding: Harvard T H Chan School of Public Health McLennan Fund: Dean's Challenge Grant Program and the EU's Research and Innovation programme Horizon 2020. There are no grant numbers. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.",

year = "2024",

month = mar,

day = "27",

doi = "10.1371/journal.pgph.0003019",

language = "English",

volume = "4",

journal = "PLOS Global Public Health",

issn = "2767-3375",

publisher = "Public Library of Science (PLOS)",

number = "3",

}

Diallo, AO, Marcus, ME, Flood, D, Theilmann, M, Rahim, NE, Kinlaw, A, Franceschini, N, Stürmer, T, Tien, DV, Abbasi-Kangevari, M, Agoudavi, K, Andall-Brereton, G, Aryal, K, Bahendeka, S, Brice, B, Bovet, P, Dorobantu, M, Farzadfar, F, Ghamari, S-H, Gathecha, G, Guwatudde, D, Gurung, M, Houehanou, C, Houinato, D, Hwalla, N, Jorgensen, J, Kagaruki, G, Karki, K, Martins, J, Mayige, M, McClure, RW, Moghaddam, SS, Mwalim, O, Mwangi, JK, Norov, B, Quesnel-Crooks, S, Sibai, A, Sturua, L, Tsabedze, L, Wesseh, C, Geldsetzer, P, Atun, R, Vollmer, S, Bärnighausen, T, Davies, J, Ali, MK, Seiglie , JA, Gower, EW & Manne-Goehler, J 2024, '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', PLOS Global Public Health, vol. 4, no. 3, e0003019. https://doi.org/10.1371/journal.pgph.0003019

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. / Diallo, Alpha Oumar ; Marcus, Maja E.; Flood, David et al.
In: PLOS Global Public Health, Vol. 4, No. 3, e0003019, 27.03.2024.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Multiple cardiovascular risk factor care in 55 low- and middle-income countries

T2 - A cross-sectional analysis of nationally-representative, individual-level data from 280,783 adults

AU - Diallo, Alpha Oumar

AU - Marcus, Maja E.

AU - Flood, David

AU - Theilmann, Michaela

AU - Rahim, Nicholas E.

AU - Kinlaw, Alan

AU - Franceschini, Nora

AU - Stürmer, Til

AU - Tien, Dessie V.

AU - Abbasi-Kangevari, Mohsen

AU - Agoudavi, Kokou

AU - Andall-Brereton, Glennis

AU - Aryal, Krishna

AU - Bahendeka, Silver

AU - Brice, Bicaba

AU - Bovet, Pascal

AU - Dorobantu, Maria

AU - Farzadfar, Farshad

AU - Ghamari, Seyyed-Hadi

AU - Gathecha, Gladwell

AU - Guwatudde, David

AU - Gurung, Mongal

AU - Houehanou, Corine

AU - Houinato, Dismand

AU - Hwalla, Nahla

AU - Jorgensen, Jutta

AU - Kagaruki, Gibson

AU - Karki, Khem

AU - Martins, Joao

AU - Mayige, Mary

AU - McClure, Roy Wong

AU - Moghaddam, Sahar Saeedi

AU - Mwalim, Omar

AU - Mwangi, Joseph Kibachio

AU - Norov, Bolormaa

AU - Quesnel-Crooks, Sarah

AU - Sibai, Abla

AU - Sturua, Lela

AU - Tsabedze, Lindiwe

AU - Wesseh, Chea

AU - Geldsetzer, Pascal

AU - Atun, Rifat

AU - Vollmer, Sebastian

AU - Bärnighausen, Till

AU - Davies, Justine

AU - Ali, Mohammed K

AU - Seiglie , Jacqueline A.

AU - Gower, Emily W.

AU - Manne-Goehler, Jennifer

N1 - Funding: Harvard T H Chan School of Public Health McLennan Fund: Dean's Challenge Grant Program and the EU's Research and Innovation programme Horizon 2020. There are no grant numbers. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

PY - 2024/3/27

Y1 - 2024/3/27

N2 - 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.

AB - 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.

UR - https://journals.plos.org/globalpublichealth/

U2 - 10.1371/journal.pgph.0003019

DO - 10.1371/journal.pgph.0003019

M3 - Article

SN - 2767-3375

VL - 4

JO - PLOS Global Public Health

JF - PLOS Global Public Health

IS - 3

M1 - e0003019

ER -

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

Abstract

Bibliographical note

UN SDGs

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