scholarly journals Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries

2020 ◽  
Vol 5 (11) ◽  
pp. e002640
Author(s):  
Clara Kayei Chow ◽  
Tu Ngoc Nguyen ◽  
Simone Marschner ◽  
Rafael Diaz ◽  
Omar Rahman ◽  
...  
Keyword(s):  
Low Income ◽  
High Income ◽  
Low Income Countries ◽  
Major Adverse Cardiovascular Events ◽  
Cvd Risk ◽  
Middle Income ◽  
Urban Rural ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

ObjectivesWe 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.MethodsWe 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.ResultsOf 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).ConclusionLower 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.

scholarly journals Contrasting Associations Between Diabetes and Cardiovascular Mortality Rates in Low-, Middle-, and High-Income Countries: Cohort Study Data From 143,567 Individuals in 21 Countries in the PURE Study

2020 ◽  
Author(s):  
Ranjit Mohan Anjana ◽  
Viswanathan Mohan ◽  
Sumathy Rangarajan ◽  
Hertzel C Gerstein ◽  
Ulagamadesan Venkatesan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Low Income ◽  
Wealth Index ◽  
Mortality Rates ◽  
Study Data ◽  
High Income ◽  
Low Income Countries ◽  
Middle Income ◽  
Urban Rural ◽  
Design And Methods

<b>Objectives: </b>We aimed to compare cardiovascular (CV) events, all-cause and CV mortality rates, among adults with and without diabetes in countries with differing levels of income. <p><b>Research design and methods:<a></a><a> </a></b>Prospective Urban Rural Epidemiological (PURE) enrolled 143,567 adults aged 35 to 70 years from 4 high income countries (HIC), 12 middle income countries (MIC) and 5 low income countries (LIC). The mean follow-up was 9.0±3.0 years. </p> <p><b>Results:</b> Among those with diabetes, CVD rates (LIC 10.3, MIC 9.2, HIC 8.3 per 1000 person years, p<0.001), all-cause mortality (LIC 13.8, MIC 7.2, HIC 4.2 per 1000 person years, p<0.001) and CV mortality (LIC 5.7, MIC 2.2, HIC 1.0 per 1000 person years, p<0.001) were considerably higher in LIC compared to MIC and HIC. Within LIC, mortality was higher in those in the lowest tertile of wealth index (low 14.7%, middle 10.8%, high 6.5%). In contrast to HIC and MIC, the increased CV mortality in those with diabetes in LIC remained unchanged even after adjustment for behavioural risk factors and treatments [Hazards ratio (95% Confidence Interval): 1.89 (1.58 – 2.27) to 1.78 (1.36 – 2.34)].</p> <p><b>Conclusions: </b>CVD rates, all-cause and CV mortality were markedly higher among those with diabetes in LIC compared to MIC and HIC with mortality risk remaining unchanged even after adjustment for risk factors and treatments. There is an urgent need to improve access to care to those with diabetes in LIC to reduce the excess mortality rates, particularly among those in the poorer strata of society. </p>

scholarly journals Contrasting associations between diabetes and cardiovascular mortality rates in low, middle and high-income countries – Cohort study data from 143,567 individuals in 21 countries – The PURE study

2020 ◽  
Author(s):  
Ranjit Mohan Anjana ◽  
Viswanathan Mohan ◽  
Sumathy Rangarajan ◽  
Hertzel C Gerstein ◽  
Ulagamadesan Venkatesan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Low Income ◽  
Wealth Index ◽  
Mortality Rates ◽  
Study Data ◽  
High Income ◽  
Low Income Countries ◽  
Middle Income ◽  
Urban Rural ◽  
Design And Methods

<b>Objectives: </b>We aimed to compare cardiovascular (CV) events, all-cause and CV mortality rates, among adults with and without diabetes in countries with differing levels of income. <p><b>Research design and methods:<a></a><a> </a></b>Prospective Urban Rural Epidemiological (PURE) enrolled 143,567 adults aged 35 to 70 years from 4 high income countries (HIC), 12 middle income countries (MIC) and 5 low income countries (LIC). The mean follow-up was 9.0±3.0 years. </p> <p><b>Results:</b> Among those with diabetes, CVD rates (LIC 10.3, MIC 9.2, HIC 8.3 per 1000 person years, p<0.001), all-cause mortality (LIC 13.8, MIC 7.2, HIC 4.2 per 1000 person years, p<0.001) and CV mortality (LIC 5.7, MIC 2.2, HIC 1.0 per 1000 person years, p<0.001) were considerably higher in LIC compared to MIC and HIC. Within LIC, mortality was higher in those in the lowest tertile of wealth index (low 14.7%, middle 10.8%, high 6.5%). In contrast to HIC and MIC, the increased CV mortality in those with diabetes in LIC remained unchanged even after adjustment for behavioural risk factors and treatments [Hazards ratio (95% Confidence Interval): 1.89 (1.58 – 2.27) to 1.78 (1.36 – 2.34)].</p> <p><b>Conclusions: </b>CVD rates, all-cause and CV mortality were markedly higher among those with diabetes in LIC compared to MIC and HIC with mortality risk remaining unchanged even after adjustment for risk factors and treatments. There is an urgent need to improve access to care to those with diabetes in LIC to reduce the excess mortality rates, particularly among those in the poorer strata of society. </p>

scholarly journals Contrasting Associations Between Diabetes and Cardiovascular Mortality Rates in Low-, Middle-, and High-Income Countries: Cohort Study Data From 143,567 Individuals in 21 Countries in the PURE Study

2020 ◽  
Author(s):  
Ranjit Mohan Anjana ◽  
Viswanathan Mohan ◽  
Sumathy Rangarajan ◽  
Hertzel C Gerstein ◽  
Ulagamadesan Venkatesan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Low Income ◽  
Wealth Index ◽  
Mortality Rates ◽  
Study Data ◽  
High Income ◽  
Low Income Countries ◽  
Middle Income ◽  
Urban Rural ◽  
Design And Methods

<b>Objectives: </b>We aimed to compare cardiovascular (CV) events, all-cause and CV mortality rates, among adults with and without diabetes in countries with differing levels of income. <p><b>Research design and methods:<a></a><a> </a></b>Prospective Urban Rural Epidemiological (PURE) enrolled 143,567 adults aged 35 to 70 years from 4 high income countries (HIC), 12 middle income countries (MIC) and 5 low income countries (LIC). The mean follow-up was 9.0±3.0 years. </p> <p><b>Results:</b> Among those with diabetes, CVD rates (LIC 10.3, MIC 9.2, HIC 8.3 per 1000 person years, p<0.001), all-cause mortality (LIC 13.8, MIC 7.2, HIC 4.2 per 1000 person years, p<0.001) and CV mortality (LIC 5.7, MIC 2.2, HIC 1.0 per 1000 person years, p<0.001) were considerably higher in LIC compared to MIC and HIC. Within LIC, mortality was higher in those in the lowest tertile of wealth index (low 14.7%, middle 10.8%, high 6.5%). In contrast to HIC and MIC, the increased CV mortality in those with diabetes in LIC remained unchanged even after adjustment for behavioural risk factors and treatments [Hazards ratio (95% Confidence Interval): 1.89 (1.58 – 2.27) to 1.78 (1.36 – 2.34)].</p> <p><b>Conclusions: </b>CVD rates, all-cause and CV mortality were markedly higher among those with diabetes in LIC compared to MIC and HIC with mortality risk remaining unchanged even after adjustment for risk factors and treatments. There is an urgent need to improve access to care to those with diabetes in LIC to reduce the excess mortality rates, particularly among those in the poorer strata of society. </p>

scholarly journals Pediatric neurosurgical workforce, access to care, equipment and training needs worldwide

2018 ◽  
Vol 45 (4) ◽  
pp. E13 ◽  
Author(s):  
Michael C. Dewan ◽  
Ronnie E. Baticulon ◽  
Abbas Rattani ◽  
James M. Johnston ◽  
Benjamin C. Warf ◽  
...  
Keyword(s):  
Low Income ◽  
International Collaboration ◽  
Eastern Mediterranean ◽  
Training Needs ◽  
High Income ◽  
Low Income Countries ◽  
Middle Income ◽  
Middle Income Countries ◽  
Surgical Workforce ◽  
And Training

OBJECTIVEThe presence and capability of existing pediatric neurosurgical care worldwide is unknown. The objective of this study was to solicit the expertise of specialists to quantify the geographic representation of pediatric neurosurgeons, access to specialist care, and equipment and training needs globally.METHODSA mixed-question survey was sent to surgeon members of several international neurosurgical and general pediatric surgical societies via a web-based platform. Respondents answered questions on 5 categories: surgeon demographics and training, hospital and practice details, surgical workforce and access to neurosurgical care, training and equipment needs, and desire for international collaboration. Responses were anonymized and analyzed using Stata software.RESULTSA total of 459 surgeons from 76 countries responded. Pediatric neurosurgeons in high-income and upper-middle-income countries underwent formal pediatric training at a greater rate than surgeons in low- and lower-middle-income countries (89.5% vs 54.4%). There are an estimated 2297 pediatric neurosurgeons in practice globally, with 85.6% operating in high-income and upper-middle-income countries. In low- and lower-middle-income countries, roughly 330 pediatric neurosurgeons care for a total child population of 1.2 billion. In low-income countries in Africa, the density of pediatric neurosurgeons is roughly 1 per 30 million children. A higher proportion of patients in low- and lower-middle-income countries must travel > 2 hours to seek emergency neurosurgical care, relative to high-income countries (75.6% vs 33.6%, p < 0.001). Vast basic and essential training and equipment needs exist, particularly low- and lower-middle-income countries within Africa, South America, the Eastern Mediterranean, and South-East Asia. Eighty-nine percent of respondents demonstrated an interest in international collaboration for the purposes of pediatric neurosurgical capacity building.CONCLUSIONSWide disparity in the access to pediatric neurosurgical care exists globally. In low- and lower-middle-income countries, wherein there exists the greatest burden of pediatric neurosurgical disease, there is a grossly insufficient presence of capable providers and equipped facilities. Neurosurgeons across income groups and geographic regions share a desire for collaboration and partnership.

scholarly journals The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study

The Lancet ◽  
2017 ◽  
Vol 390 (10113) ◽  
pp. 2643-2654 ◽  
Author(s):  
Scott A Lear ◽  
Weihong Hu ◽  
Sumathy Rangarajan ◽  
Danijela Gasevic ◽  
Darryl Leong ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cardiovascular Disease ◽  
Low Income ◽  
High Income ◽  
Low Income Countries ◽  
Middle Income

Globalization and Environment: An Asian Experience

2018 ◽  
Vol 09 (03) ◽  
pp. 1850010 ◽  
Author(s):  
Sudeshna Ghosh
Keyword(s):  
Granger Causality ◽  
Low Income ◽  
High Income ◽  
Low Income Countries ◽  
Environmental Damage ◽  
Empirical Observation ◽  
Middle Income ◽  
Middle Income Countries ◽  
Long Run ◽  
Low Middle Income Countries

This paper explores the causal association between globalization and carbon dioxide emanations in a panel set of 17 low- and low-middle-income countries and 12 upper-middle and high-income countries of Asia, respectively. The time series of observations run from 1974 to 2014. The Westerlund (2007) panel cointegration test reveals that there exists a long-run cointegrating relationship in both the panel set of observations between globalization and CO2 emissions. For the panel of upper-middle and high-income countries of Asia the long-run panel (heterogeneous elasticities) shows that globalization does not cause environmental damage, contrary to the observation based on lower- and lower-middle-income countries. The study is in conformity with the Environmental Kuznets Curve Hypothesis. The Granger causality between the variables is explored by utilizing the Dumitrescu and Hurlin (2012) Granger Causality tests. The empirical observation shows that globalization-led environmental causality is valid for lower- and lower-middle-income countries of Asia. So proper sustainable green and clean technology must be adopted for the low-income countries to stop the negation of the growth process in the near future.

scholarly journals Orthopaedic research in low-income countries: A bibliometric analysis of the current literature

SICOT-J ◽  
2019 ◽  
Vol 5 ◽  
pp. 41
Author(s):  
Simon Matthew Graham ◽  
Ciaran Brennan ◽  
Maritz Laubscher ◽  
Sithombo Maqungo ◽  
David G. Lalloo ◽  
...  
Keyword(s):  
Bibliometric Analysis ◽  
Low Income ◽  
Geographic Origin ◽  
High Income ◽  
Low Income Countries ◽  
Level Of Evidence ◽  
Middle Income ◽  
Middle Income Countries ◽  
Orthopaedic Research ◽  
Level I

Background: To perform a bibliometric analysis and quantify the amount of orthopaedic and trauma literature published from low-income countries (LICs). Methods and methods: The Web of Science database was utilised to identify all indexed orthopaedic journals. All articles published in the 76 orthopaedics journals over the last 10 years were reviewed, to determine their geographic origin. Results: A total of 131 454 articles were published across 76 orthopaedic journals over the last 10 years. Of these, 132 (0.1%) were published from LICs and 3515 (2.7%) were published from lower middle-income countries (LMICs); 85.7% (n = 112 716) of published orthopaedic research was undertaken in a high-income setting. The majority of the studies (n = 90, 74.4%) presented level IV evidence. Only 7.4% (n = 9) were high-quality evidence (level I or II). Additionally, the majority of research (74 articles, 56%) was published in partnership with high-income countries (HICs). Conclusions: There is a stark mismatch between the publication of scientific reports on orthopaedic research and the geographical areas of greatest clinical need. We believe there is an urgent need for orthopaedic research to be carried out in low-income settings to guide treatment and improve outcomes, rather than assuming that evidence from high-income settings will translate into this environment. Level of evidence: IV

scholarly journals Influence of Alcohol and Red Meat Consumption on Life Expectancy: Results of 164 Countries from 1992 to 2013

Nutrients ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 459 ◽  
Author(s):  
Chhabi Lal Ranabhat ◽  
Myung-Bae Park ◽  
Chun-Bae Kim
Keyword(s):  
Alcohol Consumption ◽  
Life Expectancy ◽  
Low Income ◽  
Meat Consumption ◽  
Red Meat ◽  
High Income ◽  
Low Income Countries ◽  
Middle Income ◽  
Middle Income Countries ◽  
High Consumption

Background: High consumption of red meat, which is carcinogenic to humans, and misuse or abuse of alcohol drinking increase premature death and shortened life expectancy. The aim of this study was to examine the association of alcohol and red meat consumption with life expectancy (LE) by analyzing data from 164 countries using an ecological approach. Design: This was a longitudinal ecological study using data from the United Nation’s (UN) Food and Agriculture Organization (FAO) for 164 countries over the period 1992–2013. In regression analysis, the relationship of alcohol and red meat consumption with LE was estimated using a pooled ordinary least squares regression model. Alcohol and red meat consumption were measured every 5 years. Results: The consumption of alcohol and red meat in high-income countries (HIC) was about 4 times (36.8–143.0 kcal/capita/day) and 5 times (11.2–51.9 kcal/capita/day) higher than that in low-income countries (LIC). Red meat and alcohol consumption had a negative estimated effect on LE in HIC (b = −1.616 p = < 0.001 and b = −0.615, p = 0.003). Alcohol consumption was negatively associated with LE for all income groups, while positive relationships were found for all estimates associated with gross national income (GNI). Conclusions: Red meat and alcohol consumption appeared to have a negative impact on LE in high-income countries (HIC) and upper-middle-income countries (UMIC), although it had no significant association with LE in low-income countries (LIC) or lower-middle-income countries (LMIC). This study suggests reviewing the policies on the gradual reduction of alcohol abuse and the high consumption of red meat, particularly HIC and UMIC.

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