Abstract
Evidence on cardiovascular disease (CVD) risk factor prevalence among adults living below the World Bank’s international line for extreme poverty (those with income <$1.90 per day) globally is sparse. Here we pooled individual-level data from 105 nationally representative household surveys across 78 countries, representing 85% of people living in extreme poverty globally, and sorted individuals by country-specific measures of household income or wealth to identify those in extreme poverty. CVD risk factors (hypertension, diabetes, smoking, obesity and dyslipidaemia) were present among 17.5% (95% confidence interval (CI) 16.7–18.3%), 4.0% (95% CI 3.6–4.5%), 10.6% (95% CI 9.0–12.3%), 3.1% (95% CI 2.8–3.3%) and 1.4% (95% CI 0.9–1.9%) of adults in extreme poverty, respectively. Most were not treated for CVD-related conditions (for example, among those with hypertension earning <$1.90 per day, 15.2% (95% CI 13.3–17.1%) reported taking blood pressure-lowering medication). The main limitation of the study is likely measurement error of poverty level and CVD risk factors that could have led to an overestimation of CVD risk factor prevalence among adults in extreme poverty. Nonetheless, our results could inform equity discussions for resource allocation and design of effective interventions.
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Data availability
This study includes individual-level data from 105 surveys. Data are publicly available for 102 of these surveys. For data that are not publicly accessible and for which we have arranged specific data-use agreements, we are unable to share these data given the terms of our agreements.
Code availability
All data management and analysis code have been posted in a public repository available at https://github.com/LisaStehr/CVD-risk-factors-among-bottom-billion/tree/main. We calculated average marginal effects of Poisson regression models using R (v.4.1.3) margins package using complex survey design, with documentation available at https://cran.r-project.org/web/packages/margins/vignettes/Introduction.html.
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Acknowledgements
We would like to thank all participants in the household surveys that have been harmonized and analysed in this study. The authors received no specific funding for this work.
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P.G., R.L.T., R.A., T.B. and S.V. conceived this work. P.G., L.S., F.M., J.L., K.K.A., A.D., C.H., J.M.A.J., N.L., M.M., S.S.M., K.J.M., C.B., M.E.M., M.T., C.E., J.I.D., D.F., J.M.G., J.S., T.B. and S.V. were involved in data curation. P.G., L.S., F.M. and J.L. undertook formal analysis. P.G., L.S., F.M., J.L., M.E.M., T.B. and S.V. developed the methodology. P.G., L.S. and F.M. undertook visualization. P.G., R.L.T. and L.S. wrote the original draft. P.G., R.L.T., L.S., F.M., J.L., K.K.A., A.D., C.H., J.M.A.J., N.L., M.M., S.S.M., K.J.M., C.B., M.E.M., M.T., R.A., J.I.D., D.F., J.M.G., J.S., T.B. and S.V. were involved in reviewing and editing the final paper.
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Geldsetzer, P., Tisdale, R.L., Stehr, L. et al. The prevalence of cardiovascular disease risk factors among adults living in extreme poverty. Nat Hum Behav (2024). https://doi.org/10.1038/s41562-024-01840-9
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DOI: https://doi.org/10.1038/s41562-024-01840-9
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