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 B 1 , McKee M 2 , Balabanova D 2 , AlHabib KF 3 , Avezum AJ 4 , Bahonar A 5 Show all authors , Ismail N 6 , Chifamba J 7 , Chow CK 8 , Corsi DJ 9 , Dagenais GR 10 , Diaz R 11 , Gupta R 12 , Iqbal R 13 , Kaur M 14 , Khatib R 15 , Kruger A 16 , Kruger IM 17 , Lanas F 18 , Lopez-Jaramillo P 19 , Minfan F 20 , Mohan V 21 , Mony PK 22 , Oguz A 23 , Palileo-Villanueva LM 24 , Perel P 25 , Poirier P 26 , Rangarajan S 27 , Rensheng L 28 , Rosengren A 29 , Soman B 30 , Stuckler D 31 , Subramanian SV 32 , Teo K 15 , Tsolekile LP 33 , Wielgosz A 34 , Yaguang P 35 , Yeates K 36 , Yongzhen M 37 , Yusoff K 38 , Yusuf R 39 , Yusufali A 40 , Zatońska K 41 , Yusuf S 15

Affiliations 

  • 1 ECOHOST - The Centre for Health and Social Change, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK. benjamin.palafox@lshtm.ac.uk
  • 2 ECOHOST - The Centre for Health and Social Change, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
  • 3 Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
  • 4 Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
  • 5 Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
  • 6 Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
  • 7 Physiology Department, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
  • 8 The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
  • 9 Ottawa Hospital Research Institute, Ottawa, Canada
  • 10 Quebec Heart and Lung University Institute, Quebec City, QC, Canada
  • 11 Estudios Clinicos Latinoamerica, Rosario, Santa Fe, Argentina
  • 12 Eternal Heart Care Centre and Research Institute, Jaipur, Rajasthan, India
  • 13 Departments of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
  • 14 School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  • 15 Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
  • 16 Africa Unit for Transdisciplinary Health Research and Medical Research Council Research Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
  • 17 Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
  • 18 Universidad de la Frontera, Temuco, Chile
  • 19 Research Institute, Fundacion Oftalmologica de Santander; and Medical School, University of Santander, Floridablanca, Bucaramanga, Colombia
  • 20 Daxing Health Center, Shenyang City, Liaoning Province, China
  • 21 Madras Diabetes Research Foundation, Chennai, India
  • 22 St John's Medical College & Research Institute, Bangalore, India
  • 23 Department of Internal Medicine, Istanbul Medeniyet University, Istanbul, Turkey
  • 24 College of Medicine, University of the Philippines Manila, Manila, Philippines
  • 25 World Heart Federation, Geneva, Switzerland
  • 26 Faculté de Pharmacie, Université Laval Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
  • 27 Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
  • 28 Center for Disease Control & Prevention, Nanchang City, Jiangxi Province, China
  • 29 Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden
  • 30 Health Action by People, Thiruvananthapuram, and Achutha Menon Centre for Health Science Studies, Sree Chitra Institute for Medical Sciences & Technology, Trivandrum, Kerala, India
  • 31 Department of Sociology, University of Oxford, Oxford, UK
  • 32 Department of Social and Behavioral Sciences, Harvard University, Boston, MA, USA
  • 33 University of the Western Cape, Bellville, Western Province, South Africa
  • 34 The Ottawa Hospital, Ottawa, Ontario, Canada
  • 35 Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, FuWai Hospital, Beijing, China
  • 36 Department of Medicine, Queen's University, Kingston, Canada
  • 37 Institute of Geriatrics, Nanjing City, Jiangsu Province, China
  • 38 UCSI University, Kuala Lumpur, Malaysia
  • 39 Independent University, Dhaka, Bangladesh
  • 40 Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates
  • 41 Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
Int J Equity Health, 2016 12 08;15(1):199.
PMID: 27931255

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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