title: Wealth and cardiovascular health: a cross-sectional study of wealth-related inequalities in the awareness, treatment and control of hypertension in high-, middle- and low-income countries.
abstract: Effective policies to control hypertension require an understanding of its distribution in the population and the barriers people face along the pathway from detection through to treatment and control. One key factor is household wealth, which may enable or limit a household's ability to access health care services and adequately control such a chronic condition. This study aims to describe the scale and patterns of wealth-related inequalities in the awareness, treatment and control of hypertension in 21 countries using baseline data from the Prospective Urban and Rural Epidemiology study.
  
  
  
  A cross-section of 163,397 adults aged 35 to 70 years were recruited from 661 urban and rural communities in selected low-, middle- and high-income countries (complete data for this analysis from 151,619 participants). Using blood pressure measurements, self-reported health and household data, concentration indices adjusted for age, sex and urban-rural location, we estimate the magnitude of wealth-related inequalities in the levels of hypertension awareness, treatment, and control in each of the 21 country samples.
  
  
  
  Overall, the magnitude of wealth-related inequalities in hypertension awareness, treatment, and control was observed to be higher in poorer than in richer countries. In poorer countries, levels of hypertension awareness and treatment tended to be higher among wealthier households; while a similar pro-rich distribution was observed for hypertension control in countries at all levels of economic development. In some countries, hypertension awareness was greater among the poor (Sweden, Argentina, Poland), as was treatment (Sweden, Poland) and control (Sweden).
  
  
  
  Inequality in hypertension management outcomes decreased as countries became richer, but the considerable variation in patterns of wealth-related inequality - even among countries at similar levels of economic development - underscores the importance of health systems in improving hypertension management for all. These findings show that some, but not all, countries, including those with limited resources, have been able to achieve more equitable management of hypertension; and strategies must be tailored to national contexts to achieve optimal impact at population level.
authors.affiliation: ECOHOST - The Centre for Health and Social Change, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK. benjamin.palafox@lshtm.ac.uk.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Palafox
authors.affiliation: ECOHOST - The Centre for Health and Social Change, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: McKee
authors.affiliation: ECOHOST - The Centre for Health and Social Change, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
authors.forename: Dina
authors.initials: D
authors.lastname: Balabanova
authors.affiliation: Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Khalid F
authors.initials: KF
authors.lastname: AlHabib
authors.affiliation: Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
authors.forename: Alvaro Jr
authors.initials: AJ
authors.lastname: Avezum
authors.affiliation: Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Bahonar
authors.affiliation: Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
authors.forename: Noorhassim
authors.initials: N
authors.lastname: Ismail
authors.affiliation: Physiology Department, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: Jephat
authors.initials: J
authors.lastname: Chifamba
authors.affiliation: The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Clara K
authors.initials: CK
authors.lastname: Chow
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Canada.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Corsi
authors.affiliation: Quebec Heart and Lung University Institute, Quebec City, QC, Canada.
authors.forename: Gilles R
authors.initials: GR
authors.lastname: Dagenais
authors.affiliation: Estudios Clinicos Latinoamerica, Rosario, Santa Fe, Argentina.
authors.forename: Rafael
authors.initials: R
authors.lastname: Diaz
authors.affiliation: Eternal Heart Care Centre and Research Institute, Jaipur, Rajasthan, India.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Departments of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan.
authors.forename: Romaina
authors.initials: R
authors.lastname: Iqbal
authors.affiliation: School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Manmeet
authors.initials: M
authors.lastname: Kaur
authors.affiliation: Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Rasha
authors.initials: R
authors.lastname: Khatib
authors.affiliation: Africa Unit for Transdisciplinary Health Research and Medical Research Council Research Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.
authors.forename: Annamarie
authors.initials: A
authors.lastname: Kruger
authors.affiliation: Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.
authors.forename: Iolanthe Marike
authors.initials: IM
authors.lastname: Kruger
authors.affiliation: Universidad de la Frontera, Temuco, Chile.
authors.forename: Fernando
authors.initials: F
authors.lastname: Lanas
authors.affiliation: Research Institute, Fundacion Oftalmologica de Santander; and Medical School, University of Santander, Floridablanca, Bucaramanga, Colombia.
authors.forename: Patricio
authors.initials: P
authors.lastname: Lopez-Jaramillo
authors.affiliation: Daxing Health Center, Shenyang City, Liaoning Province, China.
authors.forename: Fu
authors.initials: F
authors.lastname: Minfan
authors.affiliation: Madras Diabetes Research Foundation, Chennai, India.
authors.forename: Viswanathan
authors.initials: V
authors.lastname: Mohan
authors.affiliation: St John's Medical College & Research Institute, Bangalore, India.
authors.forename: Prem K
authors.initials: PK
authors.lastname: Mony
authors.affiliation: Department of Internal Medicine, Istanbul Medeniyet University, Istanbul, Turkey.
authors.forename: Aytekin
authors.initials: A
authors.lastname: Oguz
authors.affiliation: College of Medicine, University of the Philippines Manila, Manila, Philippines.
authors.forename: Lia M
authors.initials: LM
authors.lastname: Palileo-Villanueva
authors.affiliation: World Heart Federation, Geneva, Switzerland.|The London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Pablo
authors.initials: P
authors.lastname: Perel
authors.affiliation: Faculté de Pharmacie, Université Laval Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Poirier
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.
authors.forename: Sumathy
authors.initials: S
authors.lastname: Rangarajan
authors.affiliation: Center for Disease Control & Prevention, Nanchang City, Jiangxi Province, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Rensheng
authors.affiliation: Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden.
authors.forename: Annika
authors.initials: A
authors.lastname: Rosengren
authors.affiliation: Health Action by People, Thiruvananthapuram, and Achutha Menon Centre for Health Science Studies, Sree Chitra Institute for Medical Sciences & Technology, Trivandrum, Kerala, India.
authors.forename: Biju
authors.initials: B
authors.lastname: Soman
authors.affiliation: Department of Sociology, University of Oxford, Oxford, UK.
authors.forename: David
authors.initials: D
authors.lastname: Stuckler
authors.affiliation: Department of Social and Behavioral Sciences, Harvard University, Boston, MA, USA.
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
authors.affiliation: Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Koon
authors.initials: K
authors.lastname: Teo
authors.affiliation: University of the Western Cape, Bellville, Western Province, South Africa.
authors.forename: Lungiswa P
authors.initials: LP
authors.lastname: Tsolekile
authors.affiliation: The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Andreas
authors.initials: A
authors.lastname: Wielgosz
authors.affiliation: Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, FuWai Hospital, Beijing, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Yaguang
authors.affiliation: Department of Medicine, Queen's University, Kingston, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Yeates
authors.affiliation: Institute of Geriatrics, Nanjing City, Jiangsu Province, China.
authors.forename: Mo
authors.initials: M
authors.lastname: Yongzhen
authors.affiliation: UCSI University, Kuala Lumpur, Malaysia.|Universiti Teknologi MARA, Selayang, Selangor, Malaysia.
authors.forename: Khalid
authors.initials: K
authors.lastname: Yusoff
authors.affiliation: Independent University, Dhaka, Bangladesh.
authors.forename: Rita
authors.initials: R
authors.lastname: Yusuf
authors.affiliation: Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates.
authors.forename: Afzalhussein
authors.initials: A
authors.lastname: Yusufali
authors.affiliation: Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Zatońska
authors.affiliation: Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
mesh_terms: D000328:Adult; D000368:Aged; D001118:Argentina; D001364:Awareness; D001794:Blood Pressure; D003430:Cross-Sectional Studies; D019049:Developed Countries; D003906:Developing Countries; D005191:Family Characteristics; D005260:Female; D006306:Health Surveys; D054625:Healthcare Disparities; D006801:Humans; D006973:Hypertension / Q000191:economics / Q000628:therapy*; D007182:Income; D008297:Male; D008875:Middle Aged; D011044:Poland; D011203:Poverty; D011446:Prospective Studies; D012424:Rural Population; D057566:Self Report; D012923:Social Class; D013548:Sweden; D014505:Urban Population
keywords: Global health; Healthcare disparities; Hypertension; Socioeconomic factors