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


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 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


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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.

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Authors and Affiliations



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 8, 903–916 (2024).

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