Prasad Manya, Gupta Sunanda
Department of Epidemiology and Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India.
Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Indian J Community Med. 2025 Mar-Apr;50(2):318-323. doi: 10.4103/ijcm.ijcm_420_23. Epub 2025 Jan 30.
The rate at which low- and middle-income countries (LMICs) are transitioning into high-burden states for noncommunicable diseases (NCDs) is currently posing a global health security threat. Not only cardiovascular disease (CVD) occurs earlier in these countries but also it is likely that individuals do not have access to adequate management procedures. The present study was undertaken to find the effect of availability of procedures for CVD management on premature mortality in NCDs and to juxtapose this with the prevalence of two main risk factors, hypertension and diabetes.
The World Health Organization's Global Health Observatory data were used, which include health-related data on its 194 member states. The correlation matrix was constructed for risk factors, income classification, availability of CVD management procedures, and premature NCD mortality. Multiple linear regression was done to find the association between availability of management procedures, income classification, and premature NCD mortality.
A negative correlation was observed between premature NCD mortality and income group and between premature NCD mortality and availability of CVD management procedures. Countries possessing fewer procedures for CVD management suffered a greater burden of premature NCD mortality, and this was in the form of a strong linear association. Income class and availability of CVD management procedures both independently affected premature NCD mortality. Each unit increase in income class and number of CVD management procedures reduced the premature NCD mortality by 7.9 and 2.8 units, respectively. The impact of both these factors on premature NCD mortality was statistically significant. Countries with higher prevalence of hypertension were seen to be possessing fewer CVD management procedures. Income groups also demonstrated disparities, with high-income countries bearing less burden of hypertension and having more ubiquitous CVD management resources.
The present study found that availability of CVD management procedures, such as thrombolysis, coronary bypass/stenting, and acute stroke care and rehabilitation, significantly reduce premature NCD mortality across the world. Countries that face higher burden of premature NCD mortality are not only the ones that are least prepared to manage them but also the ones that bear the greatest prevalence of risk factors like hypertension and diabetes. Making procedures for NCD management available in LMICs must be put on high priority on the global health agenda.
低收入和中等收入国家（LMICs）向非传染性疾病（NCDs）高负担国家转变的速度目前正构成全球卫生安全威胁。这些国家不仅心血管疾病（CVD）发病更早，而且个人可能无法获得足够的管理程序。本研究旨在探讨心血管疾病管理程序的可及性对非传染性疾病过早死亡率的影响，并将其与两个主要风险因素——高血压和糖尿病的患病率进行对比。
使用了世界卫生组织全球卫生观测站的数据，其中包括其194个成员国的健康相关数据。构建了风险因素、收入分类、心血管疾病管理程序的可及性和非传染性疾病过早死亡率之间的相关矩阵。进行多元线性回归以找出管理程序的可及性、收入分类和非传染性疾病过早死亡率之间的关联。
观察到非传染性疾病过早死亡率与收入组之间以及非传染性疾病过早死亡率与心血管疾病管理程序的可及性之间呈负相关。心血管疾病管理程序较少的国家过早非传染性疾病死亡率负担较重，且呈强线性关联。收入类别和心血管疾病管理程序的可及性均独立影响过早非传染性疾病死亡率。收入类别每增加一个单位，心血管疾病管理程序数量每增加一个单位，过早非传染性疾病死亡率分别降低7.9个单位和2.8个单位。这两个因素对过早非传染性疾病死亡率的影响在统计学上均具有显著性。高血压患病率较高的国家心血管疾病管理程序较少。收入组之间也存在差异，高收入国家高血压负担较轻，心血管疾病管理资源更普遍。
本研究发现，诸如溶栓、冠状动脉搭桥/支架置入以及急性中风护理和康复等心血管疾病管理程序的可及性可显著降低全球非传染性疾病过早死亡率。面临过早非传染性疾病死亡率较高负担的国家不仅是那些对其管理准备最不足的国家，也是高血压和糖尿病等风险因素患病率最高的国家。在低收入和中等收入国家提供非传染性疾病管理程序必须在全球卫生议程上被高度优先考虑。
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