期刊
LANCET GLOBAL HEALTH
卷 6, 期 3, 页码 E292-E301出版社
ELSEVIER SCI LTD
DOI: 10.1016/S2214-109X(18)30031-7
关键词
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资金
- Wellcome Trust [104349/Z/14/Z]
- UK Economic and Social Research Council under Secondary Data Analysis Initiative scheme [ES/L014696/1]
- Wellcome Trust
- ERC HRES [313590]
- Ministry of Higher Education Malaysia [600-RMI/LRGS 5/3]
- Marion Burke Chair of the Heart and Stroke Foundation of Canada
- Swiss Agency for Development and Cooperation/National Science Foundation under Programme for Research on Global Issues for Development [400640_160374]
- Population Health Research Institute
- Canadian Institutes of Health Research
- Heart and Stroke Foundation of Ontario
- AstraZeneca [Canada]
- Sanofi-Aventis [France]
- Sanofi-Aventis [Canada]
- Boehringer Ingelheim [Germany]
- Boehringer Ingelheim [Canada]
- Servier
- GlaxoSmithKline
- Novartis
- King Pharma
- Argentina: Fundacion ECLA
- Bangladesh: Independent University, Bangladesh
- Brazil: Unilever Health Institute, Brazil
- Canada: Public Health Agency of Canada
- Champlain Cardiovascular Disease Prevention Network
- Chile: Universidad de la Frontera
- China: National Center for Cardiovascular Diseases
- Colombia: Colciencias [6566-04-18062]
- Fundacion Oftalmologica de Santander
- India: Indian Council of Medical Research
- Malaysia: Ministry of Science, Technology and Innovation of Malaysia [100-IRDC/BIOTEK 16/6/21, 07-05-IFN-BPH 010]
- Ministry of Higher Education of Malaysia [600-RMI/LRGS/5/3]
- Universiti Teknologi MARA
- Universiti Kebangsaan Malaysia [UKM-Hejim-Komuniti-15-2010]
- occupied Palestinian territory: the UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA)
- occupied Palestinian territory
- International Development Research Centre (IDRC), Canada
- Philippines: Philippine Council for Health Research AMP
- Development (PCHRD)
- Poland: Polish Ministry of Science and Higher Education [290/W-PURE/2008/0]
- Wroclaw Medical University
- Saudi Arabia: Saudi Heart Association
- King Saud University, Riyadh, Saudi Arabia [RG-1436-013]
- South Africa: The North-West University
- SANPAD (SA and Netherlands Programme for Alternative Development)
- National Research Foundation
- Medical Research Council of South Africa
- South Africa Department of Science and Technology
- South African Sugar Association
- Faculty of Community and Health Sciences (UWC)
- Sweden: AFA Insurance
- Swedish Council for Working Life and Social Research
- King Gustaf V's and Queen Victoria's Freemasons Foundation
- Swedish Heart and Lung Foundation
- Swedish Research Council
- Swedish State
- Vastra Gotaland Region (FOUU)
- Turkey: Metabolic Syndrome Society
- AstraZeneca (Turkey)
- Sanofi-Aventis (Turkey)
- United Arab Emirates: Sheikh Hamdan Bin Rashid Al Maktoum Award For Medical Sciences
- Dubai Health Authority, Dubai, United Arab Emirates
- Mitra and Associates
- ESRC [ES/L014696/1] Funding Source: UKRI
- Economic and Social Research Council [ES/L014696/1] Funding Source: researchfish
Background There is little evidence on the use of secondary prevention medicines for cardiovascular disease by socioeconomic groups in countries at different levels of economic development. Methods We assessed use of antiplatelet, cholesterol, and blood-pressure-lowering drugs in 8492 individuals with self-reported cardiovascular disease from 21 countries enrolled in the Prospective Urban Rural Epidemiology (PURE) study. Defining one or more drugs as a minimal level of secondary prevention, wealth-related inequality was measured using the Wagstaff concentration index, scaled from -1 (pro-poor) to 1 (pro-rich), standardised by age and sex. Correlations between inequalities and national health-related indicators were estimated. Findings The proportion of patients with cardiovascular disease on three medications ranged from 0% in South Africa (95% CI 0-1.7), Tanzania (0-3.6), and Zimbabwe (0-5.1), to 49.3% in Canada (44.4-54.3). Proportions receiving at least one drug varied from 2.0% (95% CI 0.5-6.9) in Tanzania to 91.4% (86.6-94.6) in Sweden. There was significant (p<0.05) pro-rich inequality in Saudi Arabia, China, Colombia, India, Pakistan, and Zimbabwe. Pro-poor distributions were observed in Sweden, Brazil, Chile, Poland, and the occupied Palestinian territory. The strongest predictors of inequality were public expenditure on health and overall use of secondary prevention medicines. Interpretation Use of medication for secondary prevention of cardiovascular disease is alarmingly low. In many countries with the lowest use, pro-rich inequality is greatest. Policies associated with an equal or pro-poor distribution include free medications and community health programmes to support adherence to medications. Copyright (c) The Author(s). Published by Elsevier Ltd.
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