Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries.
Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries.
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DOI：
10.1136/bmjgh-2020-002640
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发表时间：
2020-11
影响因子：
8.1
通讯作者：
PURE Study
中科院分区：
文献类型：
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作者：
Chow CK;Nguyen TN;Marschner S;Diaz R;Rahman O;Avezum A;Lear SA;Teo K;Yeates KE;Lanas F;Li W;Hu B;Lopez-Jaramillo P;Gupta R;Kumar R;Mony PK;Bahonar A;Yusoff K;Khatib R;Kazmi K;Dans AL;Zatonska K;Alhabib KF;Kruger IM;Rosengren A;Gulec S;Yusufali A;Chifamba J;Rangarajan S;McKee M;Yusuf S;PURE Study
我们的目的是研究参与前瞻性城乡流行病学（PURE）研究的高收入国家（HIC）、中上收入国家（UMIC）和中低收入国家（LMIC）以及低收入国家（LIC）中心血管疾病（CVD）高风险人群中心血管疾病（CVD）药物可及性与主要心血管不良事件（MACE）之间的关系。我们将高CVD风险定义为存在以下任何一种情况：高血压、冠状动脉疾病、中风、吸烟者、糖尿病或年龄>55岁。从药房获得降血压药物、抗血小板药物和他汀类药物的可获得性和可负担性。参与者被分类为：第1组-所有三种药物都有供应，而且负担得起;第2组-所有三种药物都有供应，但负担不起;第3组-所有三种药物都没有供应。我们使用多变量考克斯比例风险模型，在国家和社区水平进行嵌套聚类，调整合并症、社会人口学和经济因素。在163466名参与者中，有93200名来自21个国家的高CVD风险（平均年龄54.7岁，49%为女性）。其中，44.9%来自组1，29.4%来自组2，25.7%来自组3。与第1组受试者相比，第2组受试者（HR 1.19，95% CI 1.07 - 1.31）和第3组受试者（HR 1.25，95% CI 1.08 - 1.50）的MACE风险较高。基本心血管药物的可获得性和可负担性较低与MACE和死亡率的风险较高相关。改善心血管疾病药物的可及性应该是全球降低心血管疾病战略的关键部分。
We aimed to examine the relationship between access to medicine for cardiovascular disease (CVD) and major adverse cardiovascular events (MACEs) among people at high risk of CVD in high-income countries (HICs), upper and lower middle-income countries (UMICs, LMICs) and low-income countries (LICs) participating in the Prospective Urban Rural Epidemiology (PURE) study. We defined high CVD risk as the presence of any of the following: hypertension, coronary artery disease, stroke, smoker, diabetes or age >55 years. Availability and affordability of blood pressure lowering drugs, antiplatelets and statins were obtained from pharmacies. Participants were categorised: group 1—all three drug types were available and affordable, group 2—all three drugs were available but not affordable and group 3—all three drugs were not available. We used multivariable Cox proportional hazard models with nested clustering at country and community levels, adjusting for comorbidities, sociodemographic and economic factors. Of 163 466 participants, there were 93 200 with high CVD risk from 21 countries (mean age 54.7, 49% female). Of these, 44.9% were from group 1, 29.4% from group 2 and 25.7% from group 3. Compared with participants from group 1, the risk of MACEs was higher among participants in group 2 (HR 1.19, 95% CI 1.07 to 1.31), and among participants from group 3 (HR 1.25, 95% CI 1.08 to 1.50). Lower availability and affordability of essential CVD medicines were associated with higher risk of MACEs and mortality. Improving access to CVD medicines should be a key part of the strategy to lower CVD globally.
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DOI：
10.2471/blt.10.084087
发表时间：
2012-03-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
Niëns, LM;Poel, E Van de;Brouwer, WBF
通讯作者：
Brouwer, WBF
影响因子：
2.1
作者：
van Mourik, Maaike S. M.;Cameron, Alexandra;Laing, Richard O.
通讯作者：
Laing, Richard O.
影响因子：
5.4
作者：
Husain, Muhammad Jami;Datta, Biplab Kumar;Kishore, Sandeep P.
通讯作者：
Kishore, Sandeep P.
影响因子：
3.7
作者：
Chow CK;Lock K;Madhavan M;Corsi DJ;Gilmore AB;Subramanian SV;Li W;Swaminathan S;Lopez-Jaramillo P;Avezum A;Lear SA;Dagenais G;Teo K;McKee M;Yusuf S
通讯作者：
Yusuf S
影响因子：
168.9
作者：
Khatib, Rasha;Mckee, Martin;Yusuf, Salim
通讯作者：
Yusuf, Salim