Article: Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries.
BMJ global health
2020 Volume 5, Issue 11
Abstract: ... income countries (HICs), upper and lower middle-income countries (UMICs, LMICs) and low-income countries ... economic factors.: Results: Of 163 466 participants, there were 93 200 with high CVD risk from 21 countries ... Conclusion: Lower availability and affordability of essential CVD medicines were associated with higher risk ...
| Abstract | 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. |
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| MeSH term(s) | Costs and Cost Analysis ; Developing Countries ; Female ; Humans ; Income ; Male ; Middle Aged ; Poverty ; Prospective Studies |
| Keywords | covid19 |
| Language | English |
| Publishing date | 2020-11-04 |
| Publishing country | England |
| Document type | Journal Article ; Research Support, Non-U.S. Gov't |
| ISSN | 2059-7908 |
| ISSN | 2059-7908 |
| DOI | 10.1136/bmjgh-2020-002640 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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