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Unmet need for hypercholesterolemia care in 35 low- and middle-income countries: A cross-sectional study of nationally representative surveys

BACKGROUND: As the prevalence of hypercholesterolemia is increasing in low- and middle-income countries (LMICs), detailed evidence is urgently needed to guide the response of health systems to this epidemic. This study sought to quantify unmet need for hypercholesterolemia care among adults in 35 LM...

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Autores principales: Marcus, Maja E., Ebert, Cara, Geldsetzer, Pascal, Theilmann, Michaela, Bicaba, Brice Wilfried, Andall-Brereton, Glennis, Bovet, Pascal, Farzadfar, Farshad, Singh Gurung, Mongal, Houehanou, Corine, Malekpour, Mohammad-Reza, Martins, Joao S., Moghaddam, Sahar Saeedi, Mohammadi, Esmaeil, Norov, Bolormaa, Quesnel-Crooks, Sarah, Wong-McClure, Roy, Davies, Justine I., Hlatky, Mark A., Atun, Rifat, Bärnighausen, Till W., Jaacks, Lindsay M., Manne-Goehler, Jennifer, Vollmer, Sebastian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575312/
https://www.ncbi.nlm.nih.gov/pubmed/34695124
http://dx.doi.org/10.1371/journal.pmed.1003841
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author Marcus, Maja E.
Ebert, Cara
Geldsetzer, Pascal
Theilmann, Michaela
Bicaba, Brice Wilfried
Andall-Brereton, Glennis
Bovet, Pascal
Farzadfar, Farshad
Singh Gurung, Mongal
Houehanou, Corine
Malekpour, Mohammad-Reza
Martins, Joao S.
Moghaddam, Sahar Saeedi
Mohammadi, Esmaeil
Norov, Bolormaa
Quesnel-Crooks, Sarah
Wong-McClure, Roy
Davies, Justine I.
Hlatky, Mark A.
Atun, Rifat
Bärnighausen, Till W.
Jaacks, Lindsay M.
Manne-Goehler, Jennifer
Vollmer, Sebastian
author_facet Marcus, Maja E.
Ebert, Cara
Geldsetzer, Pascal
Theilmann, Michaela
Bicaba, Brice Wilfried
Andall-Brereton, Glennis
Bovet, Pascal
Farzadfar, Farshad
Singh Gurung, Mongal
Houehanou, Corine
Malekpour, Mohammad-Reza
Martins, Joao S.
Moghaddam, Sahar Saeedi
Mohammadi, Esmaeil
Norov, Bolormaa
Quesnel-Crooks, Sarah
Wong-McClure, Roy
Davies, Justine I.
Hlatky, Mark A.
Atun, Rifat
Bärnighausen, Till W.
Jaacks, Lindsay M.
Manne-Goehler, Jennifer
Vollmer, Sebastian
author_sort Marcus, Maja E.
collection PubMed
description BACKGROUND: As the prevalence of hypercholesterolemia is increasing in low- and middle-income countries (LMICs), detailed evidence is urgently needed to guide the response of health systems to this epidemic. This study sought to quantify unmet need for hypercholesterolemia care among adults in 35 LMICs. METHODS AND FINDINGS: We pooled individual-level data from 129,040 respondents aged 15 years and older from 35 nationally representative surveys conducted between 2009 and 2018. Hypercholesterolemia care was quantified using cascade of care analyses in the pooled sample and by region, country income group, and country. Hypercholesterolemia was defined as (i) total cholesterol (TC) ≥240 mg/dL or self-reported lipid-lowering medication use and, alternatively, as (ii) low-density lipoprotein cholesterol (LDL-C) ≥160 mg/dL or self-reported lipid-lowering medication use. Stages of the care cascade for hypercholesterolemia were defined as follows: screened (prior to the survey), aware of diagnosis, treated (lifestyle advice and/or medication), and controlled (TC <200 mg/dL or LDL-C <130 mg/dL). We further estimated how age, sex, education, body mass index (BMI), current smoking, having diabetes, and having hypertension are associated with cascade progression using modified Poisson regression models with survey fixed effects. High TC prevalence was 7.1% (95% CI: 6.8% to 7.4%), and high LDL-C prevalence was 7.5% (95% CI: 7.1% to 7.9%). The cascade analysis showed that 43% (95% CI: 40% to 45%) of study participants with high TC and 47% (95% CI: 44% to 50%) with high LDL-C ever had their cholesterol measured prior to the survey. About 31% (95% CI: 29% to 33%) and 36% (95% CI: 33% to 38%) were aware of their diagnosis; 29% (95% CI: 28% to 31%) and 33% (95% CI: 31% to 36%) were treated; 7% (95% CI: 6% to 9%) and 19% (95% CI: 18% to 21%) were controlled. We found substantial heterogeneity in cascade performance across countries and higher performances in upper-middle-income countries and the Eastern Mediterranean, Europe, and Americas. Lipid screening was significantly associated with older age, female sex, higher education, higher BMI, comorbid diagnosis of diabetes, and comorbid diagnosis of hypertension. Awareness of diagnosis was significantly associated with older age, higher BMI, comorbid diagnosis of diabetes, and comorbid diagnosis of hypertension. Lastly, treatment of hypercholesterolemia was significantly associated with comorbid hypertension and diabetes, and control of lipid measures with comorbid diabetes. The main limitations of this study are a potential recall bias in self-reported information on received health services as well as diminished comparability due to varying survey years and varying lipid guideline application across country and clinical settings. CONCLUSIONS: Cascade performance was poor across all stages, indicating large unmet need for hypercholesterolemia care in this sample of LMICs—calling for greater policy and research attention toward this cardiovascular disease (CVD) risk factor and highlighting opportunities for improved prevention of CVD.
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spelling pubmed-85753122021-11-09 Unmet need for hypercholesterolemia care in 35 low- and middle-income countries: A cross-sectional study of nationally representative surveys Marcus, Maja E. Ebert, Cara Geldsetzer, Pascal Theilmann, Michaela Bicaba, Brice Wilfried Andall-Brereton, Glennis Bovet, Pascal Farzadfar, Farshad Singh Gurung, Mongal Houehanou, Corine Malekpour, Mohammad-Reza Martins, Joao S. Moghaddam, Sahar Saeedi Mohammadi, Esmaeil Norov, Bolormaa Quesnel-Crooks, Sarah Wong-McClure, Roy Davies, Justine I. Hlatky, Mark A. Atun, Rifat Bärnighausen, Till W. Jaacks, Lindsay M. Manne-Goehler, Jennifer Vollmer, Sebastian PLoS Med Research Article BACKGROUND: As the prevalence of hypercholesterolemia is increasing in low- and middle-income countries (LMICs), detailed evidence is urgently needed to guide the response of health systems to this epidemic. This study sought to quantify unmet need for hypercholesterolemia care among adults in 35 LMICs. METHODS AND FINDINGS: We pooled individual-level data from 129,040 respondents aged 15 years and older from 35 nationally representative surveys conducted between 2009 and 2018. Hypercholesterolemia care was quantified using cascade of care analyses in the pooled sample and by region, country income group, and country. Hypercholesterolemia was defined as (i) total cholesterol (TC) ≥240 mg/dL or self-reported lipid-lowering medication use and, alternatively, as (ii) low-density lipoprotein cholesterol (LDL-C) ≥160 mg/dL or self-reported lipid-lowering medication use. Stages of the care cascade for hypercholesterolemia were defined as follows: screened (prior to the survey), aware of diagnosis, treated (lifestyle advice and/or medication), and controlled (TC <200 mg/dL or LDL-C <130 mg/dL). We further estimated how age, sex, education, body mass index (BMI), current smoking, having diabetes, and having hypertension are associated with cascade progression using modified Poisson regression models with survey fixed effects. High TC prevalence was 7.1% (95% CI: 6.8% to 7.4%), and high LDL-C prevalence was 7.5% (95% CI: 7.1% to 7.9%). The cascade analysis showed that 43% (95% CI: 40% to 45%) of study participants with high TC and 47% (95% CI: 44% to 50%) with high LDL-C ever had their cholesterol measured prior to the survey. About 31% (95% CI: 29% to 33%) and 36% (95% CI: 33% to 38%) were aware of their diagnosis; 29% (95% CI: 28% to 31%) and 33% (95% CI: 31% to 36%) were treated; 7% (95% CI: 6% to 9%) and 19% (95% CI: 18% to 21%) were controlled. We found substantial heterogeneity in cascade performance across countries and higher performances in upper-middle-income countries and the Eastern Mediterranean, Europe, and Americas. Lipid screening was significantly associated with older age, female sex, higher education, higher BMI, comorbid diagnosis of diabetes, and comorbid diagnosis of hypertension. Awareness of diagnosis was significantly associated with older age, higher BMI, comorbid diagnosis of diabetes, and comorbid diagnosis of hypertension. Lastly, treatment of hypercholesterolemia was significantly associated with comorbid hypertension and diabetes, and control of lipid measures with comorbid diabetes. The main limitations of this study are a potential recall bias in self-reported information on received health services as well as diminished comparability due to varying survey years and varying lipid guideline application across country and clinical settings. CONCLUSIONS: Cascade performance was poor across all stages, indicating large unmet need for hypercholesterolemia care in this sample of LMICs—calling for greater policy and research attention toward this cardiovascular disease (CVD) risk factor and highlighting opportunities for improved prevention of CVD. Public Library of Science 2021-10-25 /pmc/articles/PMC8575312/ /pubmed/34695124 http://dx.doi.org/10.1371/journal.pmed.1003841 Text en © 2021 Marcus et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Marcus, Maja E.
Ebert, Cara
Geldsetzer, Pascal
Theilmann, Michaela
Bicaba, Brice Wilfried
Andall-Brereton, Glennis
Bovet, Pascal
Farzadfar, Farshad
Singh Gurung, Mongal
Houehanou, Corine
Malekpour, Mohammad-Reza
Martins, Joao S.
Moghaddam, Sahar Saeedi
Mohammadi, Esmaeil
Norov, Bolormaa
Quesnel-Crooks, Sarah
Wong-McClure, Roy
Davies, Justine I.
Hlatky, Mark A.
Atun, Rifat
Bärnighausen, Till W.
Jaacks, Lindsay M.
Manne-Goehler, Jennifer
Vollmer, Sebastian
Unmet need for hypercholesterolemia care in 35 low- and middle-income countries: A cross-sectional study of nationally representative surveys
title Unmet need for hypercholesterolemia care in 35 low- and middle-income countries: A cross-sectional study of nationally representative surveys
title_full Unmet need for hypercholesterolemia care in 35 low- and middle-income countries: A cross-sectional study of nationally representative surveys
title_fullStr Unmet need for hypercholesterolemia care in 35 low- and middle-income countries: A cross-sectional study of nationally representative surveys
title_full_unstemmed Unmet need for hypercholesterolemia care in 35 low- and middle-income countries: A cross-sectional study of nationally representative surveys
title_short Unmet need for hypercholesterolemia care in 35 low- and middle-income countries: A cross-sectional study of nationally representative surveys
title_sort unmet need for hypercholesterolemia care in 35 low- and middle-income countries: a cross-sectional study of nationally representative surveys
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575312/
https://www.ncbi.nlm.nih.gov/pubmed/34695124
http://dx.doi.org/10.1371/journal.pmed.1003841
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