A study published in the journal Nature Human Behavior estimates the prevalence of CVD risk factors among adults living in extreme poverty.
Study: Prevalence of CVD risk factors among adults living in extreme poverty. Image credit: Cozine / Shutterstock
Record
It is generally believed that adults living in extreme poverty in low- and middle-income countries have a lower prevalence of cardiovascular disease and its risk factors, such as obesity, diabetes, hypertension, dyslipidemia, and smoking.
Adults living in extreme poverty generally consume plant-based foods with lower caloric value and are engaged in occupations that require high-intensity physical activities. These lifestyle patterns are probably responsible for a lower risk of cardiovascular disease.
Accurately estimating the prevalence of cardiovascular risk factors in this subpopulation is particularly important for guiding health policy and health care delivery. However, only limited data on this topic are currently available from nationally representative surveys.
In this study, scientists estimated the prevalence of five major CVD risk factors, including hypertension, diabetes, obesity, dyslipidemia, and smoking, among adults living below the World Bank’s international threshold for extreme poverty ( those with income < $1.90 per day). worldwide.
Study design
The scientists collected individual-level data from 105 nationally representative household surveys in 78 countries. This represents 85% of the world’s population living in extreme poverty. They identified this subpopulation by sorting the individual-level data by measures of household income or wealth in specific countries.
Data obtained from a total of 32,695,579 participants were analyzed in the study. Of all participants, 7,922,289 lived in extreme poverty (income <$1.90 per day), 806,381 on $1.90–$3.19 per day, 748,078 on $3.20–5.49 per day, and 922,870 at $5.50 or more per day.
Important observations
The estimated prevalence of five major CVD risk factors among adults living in extreme poverty was 17.5% for hypertension, 4.0% for diabetes, 10.6% for current smoking, 3.1% for obesity and 1.4% for dyslipidemia.
Among adults earning higher incomes (>$5.50 per day), the prevalence of hypertension, diabetes, smoking, obesity, and dyslipidemia was estimated to be 20.8%, 7.6%, 21.1%, 14.2% and 17%, respectively.
In low- and upper-middle-income countries, the prevalence of these risk factors among adults living in extreme poverty was not significantly lower than among those with higher incomes.
Specifically, no significant difference in diabetes prevalence was observed between extremely poor adults and those with higher incomes in low- and upper-middle-income countries. However, in lower- and middle-income countries, a higher prevalence of diabetes was observed among those with higher incomes. A similar pattern was observed for the prevalence of hypertension.
Like the prevalence of diabetes, a low prevalence of smoking and dyslipidemia was observed across poverty levels in low-income countries, and a high prevalence was observed among population income groups in upper-middle-income countries. Only in lower- and middle-income countries was variation in the prevalence of these risk factors between poverty levels observed.
Obesity prevalence, on the other hand, showed a positive correlation with poverty levels.
Demographic variation in prevalence
Stratification of CVD risk factor prevalence among poor adults by type of residence revealed that urban residents have a higher prevalence of diabetes than rural residents.
A similar stratification by gender revealed that men have a slightly higher prevalence of hypertension, a significantly higher prevalence of smoking, and a significantly lower prevalence of obesity than women.
A stratification by education revealed a higher prevalence of smoking among those with high school and above compared to those with no schooling.
Treatments of cardiovascular risk factors
Among poor adults with hypertension, about 15% reported taking blood pressure-lowering medications and 5% reported achieving hypertension control. Among people with diabetes, about 19% reported taking medication to lower blood glucose. Among those who needed a statin (cholesterol-lowering drug) for secondary prevention of cardiovascular disease, only 1% reported taking the drug.
Lower use of hypertension drugs, antidiabetics and statins was observed at each poverty level in low-income countries. The likelihood of taking these drugs was consistently lower among adults living in more extreme levels of poverty in lower- and middle-income countries. These patterns were less evident in upper-middle-income countries.
Importance of study
Study finds high prevalence of CVD risk factors among adults living in extreme poverty. This observation contrasts with the current perception of a low prevalence of these risk factors in this subpopulation, mainly due to their highly active lifestyles and low-calorie dietary habits.
The study can inform discussions about equity in resource allocation and the design of effective interventions.
