Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries
Objectives We aimed to examine the relationship between access to medicine for cardiovascular disease (CVD) and major adverse cardiovascular events (MACEs) among people at high risk of CVD in high-income countries (HICs), upper and lower middle-income countries (UMICs, LMICs) and low-income countrie...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2020-11-01
|
| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/5/11/e002640.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1846137872496721920 |
|---|---|
| author | Annika Rosengren Khalid Yusoff Karen E Yeates Wei Li Rajeev Gupta Koon Teo Sumathy Rangarajan Scott A Lear Rasha Khatib Rafael Diaz Alvaro Avezum Fernando Lanas Khalid F Alhabib Jephat Chifamba Salim Yusuf Omar Rahman Prem K Mony Bo Hu Antonio L Dans Iolanthe Marike Kruger Katarzyna Zatonska Simone Marschner Rajesh Kumar Afzalhussein Yusufali Tu Ngoc Nguyen Ahmad Bahonar Clara Kayei Chow Khawar Kazmi Sadi Gulec |
| author_facet | Annika Rosengren Khalid Yusoff Karen E Yeates Wei Li Rajeev Gupta Koon Teo Sumathy Rangarajan Scott A Lear Rasha Khatib Rafael Diaz Alvaro Avezum Fernando Lanas Khalid F Alhabib Jephat Chifamba Salim Yusuf Omar Rahman Prem K Mony Bo Hu Antonio L Dans Iolanthe Marike Kruger Katarzyna Zatonska Simone Marschner Rajesh Kumar Afzalhussein Yusufali Tu Ngoc Nguyen Ahmad Bahonar Clara Kayei Chow Khawar Kazmi Sadi Gulec |
| author_sort | Annika Rosengren |
| collection | DOAJ |
| description | Objectives We aimed to examine the relationship between access to medicine for cardiovascular disease (CVD) and major adverse cardiovascular events (MACEs) among people at high risk of CVD in high-income countries (HICs), upper and lower middle-income countries (UMICs, LMICs) and low-income countries (LICs) participating in the Prospective Urban Rural Epidemiology (PURE) study.Methods We defined high CVD risk as the presence of any of the following: hypertension, coronary artery disease, stroke, smoker, diabetes or age >55 years. Availability and affordability of blood pressure lowering drugs, antiplatelets and statins were obtained from pharmacies. Participants were categorised: group 1—all three drug types were available and affordable, group 2—all three drugs were available but not affordable and group 3—all three drugs were not available. We used multivariable Cox proportional hazard models with nested clustering at country and community levels, adjusting for comorbidities, sociodemographic and economic factors.Results Of 163 466 participants, there were 93 200 with high CVD risk from 21 countries (mean age 54.7, 49% female). Of these, 44.9% were from group 1, 29.4% from group 2 and 25.7% from group 3. Compared with participants from group 1, the risk of MACEs was higher among participants in group 2 (HR 1.19, 95% CI 1.07 to 1.31), and among participants from group 3 (HR 1.25, 95% CI 1.08 to 1.50).Conclusion Lower availability and affordability of essential CVD medicines were associated with higher risk of MACEs and mortality. Improving access to CVD medicines should be a key part of the strategy to lower CVD globally. |
| format | Article |
| id | doaj-art-53db6de5806c4067b72a59d1279a106c |
| institution | Kabale University |
| issn | 2059-7908 |
| language | English |
| publishDate | 2020-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-53db6de5806c4067b72a59d1279a106c2024-12-07T20:50:18ZengBMJ Publishing GroupBMJ Global Health2059-79082020-11-0151110.1136/bmjgh-2020-002640Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countriesAnnika Rosengren0Khalid Yusoff1Karen E Yeates2Wei Li3Rajeev Gupta4Koon Teo5Sumathy Rangarajan6Scott A Lear7Rasha Khatib8Rafael Diaz9Alvaro Avezum10Fernando Lanas11Khalid F Alhabib12Jephat Chifamba13Salim Yusuf14Omar Rahman15Prem K Mony16Bo Hu17Antonio L Dans18Iolanthe Marike Kruger19Katarzyna Zatonska20Simone Marschner21Rajesh Kumar22Afzalhussein Yusufali23Tu Ngoc Nguyen24Ahmad Bahonar25Clara Kayei Chow26Khawar Kazmi27Sadi Gulec28Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenUiTM, Selayang, Selangor and UCSI University, Cheras, Kuala Lumpur, MalaysiaDepartment of Medicine, Queen`s University, Kingston, New Hampshire, CanadaDepartment of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USAMedicine, Eternal Heart Care Centre and Research Institute, Jaipur, Rajasthan, IndiaPopulation Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, CanadaPopulation Health Research Institute, McMaster University, Hamilton, Ontario, CanadaPopulation Health Research Institute, Hamilton, Ontario, CanadaAdvocate Aurora Enterprises, Downers Grove, Illinois, USAECLA - Academic Research Organization, Rosario, ArgentinaInternational Research Center, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil30 Internal Medicine, Universidad de La Frontera, Temuco, ChileDepartment of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi ArabiaDepartment of Physiology, University of Zimbabwe, Harare, ZimbabwePopulation Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, CanadaUniversity of Liberal Arts Bangladesh, Dhaka, BangladeshDivision of Epidemiology & Population Health, St John`s Medical College and Research Institute, Bangalore, India1 Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, ChinaProgram on Health Systems Development - Philippine Primary Care Studies, Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, PhilippinesAfrica Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South AfricaDepartment of Social Medicine, Wroclaw Medical University, Wroclaw, Poland1 Westmead Applied Research Centre, The University of Sydney, Westmead, New South Wales, AustraliaU.O. Rheumatology and Clinical immunology, ASST Spedali Civili of Brescia, Clinical and Experimental Sciences, BRESCIA, ItalyprofessorWestmead Apllied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, AustraliaIsfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran (the Islamic Republic of)Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, AustraliaDepartment of Medicine, Aga Khan University, Karachi, PakistanCardiology Department, Ankara University School of Medicine, Ankara, TurkeyObjectives We aimed to examine the relationship between access to medicine for cardiovascular disease (CVD) and major adverse cardiovascular events (MACEs) among people at high risk of CVD in high-income countries (HICs), upper and lower middle-income countries (UMICs, LMICs) and low-income countries (LICs) participating in the Prospective Urban Rural Epidemiology (PURE) study.Methods We defined high CVD risk as the presence of any of the following: hypertension, coronary artery disease, stroke, smoker, diabetes or age >55 years. Availability and affordability of blood pressure lowering drugs, antiplatelets and statins were obtained from pharmacies. Participants were categorised: group 1—all three drug types were available and affordable, group 2—all three drugs were available but not affordable and group 3—all three drugs were not available. We used multivariable Cox proportional hazard models with nested clustering at country and community levels, adjusting for comorbidities, sociodemographic and economic factors.Results Of 163 466 participants, there were 93 200 with high CVD risk from 21 countries (mean age 54.7, 49% female). Of these, 44.9% were from group 1, 29.4% from group 2 and 25.7% from group 3. Compared with participants from group 1, the risk of MACEs was higher among participants in group 2 (HR 1.19, 95% CI 1.07 to 1.31), and among participants from group 3 (HR 1.25, 95% CI 1.08 to 1.50).Conclusion Lower availability and affordability of essential CVD medicines were associated with higher risk of MACEs and mortality. Improving access to CVD medicines should be a key part of the strategy to lower CVD globally.https://gh.bmj.com/content/5/11/e002640.full |
| spellingShingle | Annika Rosengren Khalid Yusoff Karen E Yeates Wei Li Rajeev Gupta Koon Teo Sumathy Rangarajan Scott A Lear Rasha Khatib Rafael Diaz Alvaro Avezum Fernando Lanas Khalid F Alhabib Jephat Chifamba Salim Yusuf Omar Rahman Prem K Mony Bo Hu Antonio L Dans Iolanthe Marike Kruger Katarzyna Zatonska Simone Marschner Rajesh Kumar Afzalhussein Yusufali Tu Ngoc Nguyen Ahmad Bahonar Clara Kayei Chow Khawar Kazmi Sadi Gulec Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries BMJ Global Health |
| title | Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries |
| title_full | Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries |
| title_fullStr | Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries |
| title_full_unstemmed | Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries |
| title_short | Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries |
| title_sort | availability and affordability of medicines and cardiovascular outcomes in 21 high income middle income and low income countries |
| url | https://gh.bmj.com/content/5/11/e002640.full |
| work_keys_str_mv | AT annikarosengren availabilityandaffordabilityofmedicinesandcardiovascularoutcomesin21highincomemiddleincomeandlowincomecountries AT khalidyusoff availabilityandaffordabilityofmedicinesandcardiovascularoutcomesin21highincomemiddleincomeandlowincomecountries AT kareneyeates availabilityandaffordabilityofmedicinesandcardiovascularoutcomesin21highincomemiddleincomeandlowincomecountries AT weili availabilityandaffordabilityofmedicinesandcardiovascularoutcomesin21highincomemiddleincomeandlowincomecountries AT rajeevgupta availabilityandaffordabilityofmedicinesandcardiovascularoutcomesin21highincomemiddleincomeandlowincomecountries AT koonteo availabilityandaffordabilityofmedicinesandcardiovascularoutcomesin21highincomemiddleincomeandlowincomecountries AT sumathyrangarajan availabilityandaffordabilityofmedicinesandcardiovascularoutcomesin21highincomemiddleincomeandlowincomecountries AT scottalear availabilityandaffordabilityofmedicinesandcardiovascularoutcomesin21highincomemiddleincomeandlowincomecountries AT rashakhatib availabilityandaffordabilityofmedicinesandcardiovascularoutcomesin21highincomemiddleincomeandlowincomecountries AT rafaeldiaz availabilityandaffordabilityofmedicinesandcardiovascularoutcomesin21highincomemiddleincomeandlowincomecountries AT alvaroavezum availabilityandaffordabilityofmedicinesandcardiovascularoutcomesin21highincomemiddleincomeandlowincomecountries AT fernandolanas availabilityandaffordabilityofmedicinesandcardiovascularoutcomesin21highincomemiddleincomeandlowincomecountries AT khalidfalhabib availabilityandaffordabilityofmedicinesandcardiovascularoutcomesin21highincomemiddleincomeandlowincomecountries AT jephatchifamba availabilityandaffordabilityofmedicinesandcardiovascularoutcomesin21highincomemiddleincomeandlowincomecountries AT salimyusuf availabilityandaffordabilityofmedicinesandcardiovascularoutcomesin21highincomemiddleincomeandlowincomecountries AT omarrahman availabilityandaffordabilityofmedicinesandcardiovascularoutcomesin21highincomemiddleincomeandlowincomecountries AT premkmony availabilityandaffordabilityofmedicinesandcardiovascularoutcomesin21highincomemiddleincomeandlowincomecountries AT bohu availabilityandaffordabilityofmedicinesandcardiovascularoutcomesin21highincomemiddleincomeandlowincomecountries AT antonioldans availabilityandaffordabilityofmedicinesandcardiovascularoutcomesin21highincomemiddleincomeandlowincomecountries AT iolanthemarikekruger availabilityandaffordabilityofmedicinesandcardiovascularoutcomesin21highincomemiddleincomeandlowincomecountries AT katarzynazatonska availabilityandaffordabilityofmedicinesandcardiovascularoutcomesin21highincomemiddleincomeandlowincomecountries AT simonemarschner availabilityandaffordabilityofmedicinesandcardiovascularoutcomesin21highincomemiddleincomeandlowincomecountries AT rajeshkumar availabilityandaffordabilityofmedicinesandcardiovascularoutcomesin21highincomemiddleincomeandlowincomecountries AT afzalhusseinyusufali availabilityandaffordabilityofmedicinesandcardiovascularoutcomesin21highincomemiddleincomeandlowincomecountries AT tungocnguyen availabilityandaffordabilityofmedicinesandcardiovascularoutcomesin21highincomemiddleincomeandlowincomecountries AT ahmadbahonar availabilityandaffordabilityofmedicinesandcardiovascularoutcomesin21highincomemiddleincomeandlowincomecountries AT clarakayeichow availabilityandaffordabilityofmedicinesandcardiovascularoutcomesin21highincomemiddleincomeandlowincomecountries AT khawarkazmi availabilityandaffordabilityofmedicinesandcardiovascularoutcomesin21highincomemiddleincomeandlowincomecountries AT sadigulec availabilityandaffordabilityofmedicinesandcardiovascularoutcomesin21highincomemiddleincomeandlowincomecountries |