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The prevalence of cardiovascular disease risk factors among adults living in extreme poverty

Nature Human Behaviour (2024)Cite this article

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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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Fig. 1: Age-standardized prevalence (as a percentage) of CVD risk factors by poverty level in low-income, lower middle-income and upper middle-income countries.
Fig. 2: Variation in CVD risk factor prevalence among those living in extreme poverty (<$1.90 per day) by rural–urban residency, sex and education.
Fig. 3: Hypertension treatment and control, diabetes treatment and statin use, by individuals’ poverty level and World Bank country income group.

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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.

Author information

Author notes

  1. These authors contributed equally: Pascal Geldsetzer, Rebecca L. Tisdale.

  2. These authors jointly supervised this work: Till Bärnighausen, Sebastian Vollmer.

Authors and Affiliations

  1. Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA

    Pascal Geldsetzer & Felix Michalik

  2. Chan Zuckerberg Biohub – San Francisco, San Francisco, CA, USA

    Pascal Geldsetzer

  3. Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA

    Rebecca L. Tisdale

  4. Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA

    Rebecca L. Tisdale

  5. Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany

    Lisa Stehr, Felix Michalik, Julia Lemp, Christian Bommer, Michaela Theilmann & Till Bärnighausen

  6. Department for International Development/Nepal Health Sector Programme 3/Monitoring Evaluation and Operational Research, Abt Associates, Kathmandu, Nepal

    Krishna K. Aryal

  7. Department of Public and Forensic Health Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal

    Albertino Damasceno & Nuno Lunet

  8. Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin

    Corine Houehanou

  9. Institute of Global Health, Dept of Public Health and Epidemiology, Copenhagen University, Copenhagen, Denmark

    Jutta Mari Adelin Jørgensen

  10. National Institute for Medical Research, Dar es Salaam, Tanzania

    Mary Mayige

  11. Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Sahar Saeedi Moghaddam

  12. Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya

    Kibachio Joseph Mwangi

  13. Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany

    Christian Bommer, Maja-Emilia Marcus & Sebastian Vollmer

  14. Department of Economics, University of Goettingen, Göttingen, Germany

    Maja-Emilia Marcus & Sebastian Vollmer

  15. RWI-Leibniz Institute for Economic Research, Essen (Berlin Office), Berlin, Germany

    Cara Ebert

  16. Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA

    Rifat Atun

  17. Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA

    Rifat Atun

  18. Institute of Applied Health Research, University of Birmingham, Birmingham, UK

    Justine Ina Davies

  19. MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa

    Justine Ina Davies

  20. Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa

    Justine Ina Davies

  21. Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI, USA

    David Flood

  22. Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA, USA

    Jennifer Manne-Goehler

  23. Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Jennifer Manne-Goehler

  24. Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA

    Jacqueline Seiglie

  25. Department of Medicine, Harvard Medical School, Boston, MA, USA

    Jacqueline Seiglie

  26. Harvard Center for Population and Development Studies, Cambridge, MA, USA

    Till Bärnighausen

Authors
  1. Pascal Geldsetzer
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  2. Rebecca L. Tisdale
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Contributions

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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Correspondence to Pascal Geldsetzer.

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Nature Human Behaviour thanks Anthony Etyang, Rajeev Gupta, Aditya Khetan, Vahé Nafilyan and the other, anonymous, reviewer(s) for their contribution to the peer review of this work. Peer reviewer reports are available.

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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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