Diallo Alpha Oumar, Marcus Maja E, Flood David, Theilmann Michaela, Rahim Nicholas E, Kinlaw Alan, Franceschini Nora, Stürmer Til, Tien Dessie V, Abbasi-Kangevari Mohsen, Agoudavi Kokou, Andall-Brereton Glennis, Aryal Krishna, Bahendeka Silver, Bicaba Brice, Bovet Pascal, Dorobantu Maria, Farzadfar Farshad, Ghamari Seyyed-Hadi, Gathecha Gladwell, Guwatudde David, Gurung Mongal, Houehanou Corine, Houinato Dismand, Hwalla Nahla, Jorgensen Jutta, Kagaruki Gibson, Karki Khem, Martins Joao, Mayige Mary, McClure Roy Wong, Moghaddam Sahar Saeedi, Mwalim Omar, Mwangi Kibachio Joseph, Norov Bolormaa, Quesnel-Crooks Sarah, Sibai Abla, Sturua Lela, Tsabedze Lindiwe, Wesseh Chea, Geldsetzer Pascal, Atun Rifat, Vollmer Sebastian, Bärnighausen Till, Davies Justine, Ali Mohammed K, Seiglie Jacqueline A, Gower Emily W, Manne-Goehler Jennifer
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany.
PLOS Glob Public Health. 2024 Mar 27;4(3):e0003019. doi: 10.1371/journal.pgph.0003019. eCollection 2024.
The prevalence of multiple age-related cardiovascular disease (CVD) risk factors is high among individuals living in low- and middle-income countries. We described receipt of healthcare services for and management of hypertension and diabetes among individuals living with these conditions using individual-level data from 55 nationally representative population-based surveys (2009-2019) with measured blood pressure (BP) and diabetes biomarker. We restricted our analysis to non-pregnant individuals aged 40-69 years and defined three mutually exclusive groups (i.e., hypertension only, diabetes only, and both hypertension-diabetes) to compare individuals living with concurrent hypertension and diabetes to individuals with each condition separately. We included 90,086 individuals who lived with hypertension only, 11,975 with diabetes only, and 16,228 with hypertension-diabetes. We estimated the percentage of individuals who were aware of their diagnosis, used pharmacological therapy, or achieved appropriate hypertension and diabetes management. A greater percentage of individuals with hypertension-diabetes were fully diagnosed (64.1% [95% CI: 61.8-66.4]) than those with hypertension only (47.4% [45.3-49.6]) or diabetes only (46.7% [44.1-49.2]). Among the hypertension-diabetes group, pharmacological treatment was higher for individual conditions (38.3% [95% CI: 34.8-41.8] using antihypertensive and 42.3% [95% CI: 39.4-45.2] using glucose-lowering medications) than for both conditions jointly (24.6% [95% CI: 22.1-27.2]).The percentage of individuals achieving appropriate management was highest in the hypertension group (17.6% [16.4-18.8]), followed by diabetes (13.3% [10.7-15.8]) and hypertension-diabetes (6.6% [5.4-7.8]) groups. Although health systems in LMICs are reaching a larger share of individuals living with both hypertension and diabetes than those living with just one of these conditions, only seven percent achieved both BP and blood glucose treatment targets. Implementation of cost-effective population-level interventions that shift clinical care paradigm from disease-specific to comprehensive CVD care are urgently needed for all three groups, especially for those with multiple CVD risk factors.
在低收入和中等收入国家的人群中，多种与年龄相关的心血管疾病（CVD）风险因素的患病率很高。我们利用来自55项具有全国代表性的基于人群的调查（2009 - 2019年）的个体层面数据，这些数据包含测量的血压（BP）和糖尿病生物标志物，描述了患有高血压和糖尿病的个体接受医疗服务以及对这些疾病的管理情况。我们将分析限制在年龄为40 - 69岁的非孕妇个体，并定义了三个相互排斥的组（即仅患有高血压、仅患有糖尿病以及同时患有高血压和糖尿病），以比较同时患有高血压和糖尿病的个体与分别患有每种疾病的个体。我们纳入了90,086名仅患有高血压的个体、11,975名仅患有糖尿病的个体以及16,228名同时患有高血压和糖尿病的个体。我们估计了知晓自己诊断情况、使用药物治疗或实现适当的高血压和糖尿病管理的个体百分比。与仅患有高血压（47.4% [45.3 - 49.])或仅患有糖尿病（46.7% [44.1 - 49.2]）的个体相比，同时患有高血压和糖尿病的个体中被完全诊断出来的比例更高（64.1% [95% CI: 61.8 - 66.4]）。在同时患有高血压和糖尿病的组中，针对单一疾病的药物治疗比例更高（使用抗高血压药物的比例为38.3% [95% CI: 34.8 - 41.8]，使用降糖药物的比例为42.3% [95% CI: 39.4 - 45.2]），而针对两种疾病联合治疗的比例为24.6% [95% CI: 22.1 - 27.2]。实现适当管理的个体百分比在高血压组中最高（17.6% [16.4 - 18.8]），其次是糖尿病组（13.3% [10.7 - 15.8]）和高血压 - 糖尿病组（6.6% [5.4 - 7.8]）。尽管低收入和中等收入国家的卫生系统覆盖了同时患有高血压和糖尿病的个体的比例高于仅患有其中一种疾病的个体，但只有7%的个体实现了血压和血糖治疗目标。对于所有这三组人群，尤其是对于那些具有多种心血管疾病风险因素的人群，迫切需要实施具有成本效益的人群层面干预措施，将临床护理模式从针对特定疾病转变为全面的心血管疾病护理。
