Diagnostic testing for hypertension, diabetes, and hypercholesterolemia in low- and middle-income countries: a cross-sectional study of 994,185 individuals from 57 nationally representative surveys

Sophie Ochmann, Isabelle von Polenz, Maja-Emilia Marcus , Michaela Theilmann, David Flood, Kokou Agoudavi, Krishna Kumar Aryal, Bahendeka K Silver, Bicaba Brice, Pascal Bovet, Luisa Campos Caldeira Brant, Deborah Carvalho Malta, Albertino Damasceno , Farshad Farzadfar, Gladwell Gathecha, Ali Ghanbari, Mongal Gurung, David Guwatudde, Corine Houehanou, Dismand HouinatoNahla C. Hwalla , Jutta Mari Adelin Jorgensen, Khem B Karki, Nuno Lunet, Joao S Martins, Mary T Mayige, Sahar Saeedi Moghaddam, Omar Mwalim, Joseph Kibachio Mwangi, Bolormaa Norov, Sarah Quesnel-Crooks, Negar Rezaei, Abla M. Sibai , Lela Sturua, Lindiwe Tsabedze, Roy Wong-McClure, Justine Davies, Pascal Geldsetzer, Till Bärnighausen, Rifat Atun, Jennifer Manne-Goehler, Sebastian Vollmer*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

Background: Testing for the risk factors of cardiovascular disease, which include hypertension, diabetes, and hypercholesterolaemia, is important for timely and effective risk management. Yet few studies have quantified and analysed testing of cardiovascular risk factors in low-income and middle-income countries (LMICs) with respect to sociodemographic inequalities. We aimed to address this knowledge gap.

Methods: In this cross-sectional analysis, we pooled individual-level data for non-pregnant adults aged 18 years or older from nationally representative surveys done between Jan 1, 2010, and Dec 31, 2019 in LMICs that included a question about whether respondents had ever had their blood pressure, glucose, or cholesterol measured. We analysed diagnostic testing performance by quantifying the overall proportion of people who had ever been tested for these cardiovascular risk factors and the proportion of individuals who met the diagnostic testing criteria in the WHO package of essential noncommunicable disease interventions for primary care (PEN) guidelines (ie, a BMI >30 kg/m2 or a BMI >25 kg/m2 among people aged 40 years or older). We disaggregated and compared diagnostic testing performance by sex, wealth quintile, and education using two-sided t tests and multivariable logistic regression models.

Findings: Our sample included data for 994 185 people from 57 surveys. 19·1% (95% CI 18·5–19·8) of the 943 259 people in the hypertension sample met the WHO PEN criteria for diagnostic testing, of whom 78·6% (77·8–79·2) were tested. 23·8% (23·4–24·3) of the 225 707 people in the diabetes sample met the WHO PEN criteria for diagnostic testing, of whom 44·9% (43·7–46·2) were tested. Finally, 27·4% (26·3–28·6) of the 250 573 people in the hypercholesterolaemia sample met the WHO PEN criteria for diagnostic testing, of whom 39·7% (37·1–2·4) were tested. Women were more likely than men to be tested for hypertension and diabetes, and people in higher wealth quintiles compared with those in the lowest wealth quintile were more likely to be tested for all three risk factors, as were people with at least secondary education compared with those with less than primary education.

Interpretation: Our study shows opportunities for health systems in LMICs to improve the targeting of diagnostic testing for cardiovascular risk factors and adherence to diagnostic testing guidelines. Risk-factor-based testing recommendations rather than sociodemographic characteristics should determine which individuals are tested.

Funding: Harvard McLennan Family Fund, the Alexander von Humboldt Foundation, and the National Heart, Lung, and Blood Institute of the US National Institutes of Health.
Original languageEnglish
Pages (from-to)e1363–e1371
Number of pages9
JournalThe Lancet
Volume11
Issue number9
Early online date15 Aug 2023
DOIs
Publication statusPublished - Sept 2023

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