Addressing critical barriers to control of non-communicable disease (NCD) in low, middle and high income countries

解决低收入、中等收入和高收入国家控制非传染性疾病 (NCD) 的关键障碍

• 批准号: ES/L014696/1
• 负责人: Martin McKee
• 金额: $ 19.93万
• 依托单位: London School of Hygiene & Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2014
• 资助国家: 英国
• 起止时间: 2014 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=ES%2FL014696%2F1
• 关键词: Addressing; critical; barriers; control; non

The burden of disease in middle and low income countries is changing, with growing numbers of chronic diseases requiring long term treatment. Yet, the available evidence, mainly on acute conditions, shows that there are large inequalities in access to care. The goal of this project is to understand the role of health systems in shaping gender, geographical, and socio-economic inequalities in access to continuing effective care for chronic diseases in low-, middle- and high income countries, by combining two unique large data sets (the Prospective Urban and Rural Epidemiology (PURE) individual cohorts and Environmental Profile of a Community's Health (EPOCH) community profiles). These contain individual-level data from a cohort of over 170,000 individuals age 35-70 in over 600 communities in 21 countries at all levels of development (Canada, Sweden, Saudi Arabia, United Arab Emirates, Argentina, Brazil, Chile, Poland, Turkey, Malaysia, South Africa, China, Colombia, Iran, Palestine, Philippines, Bangladesh, India, Pakistan, Tanzania, Zimbabwe), including their socio-economic characteristics, clinical parameters (e.g. blood pressure, ECG, bloods, urine), treatment, health care utilisation, and outcomes, and so far followed up for 3 years, as well as profiles of the communities in which they live, including health facilities and availability and price of medicines. We will identify those with or at risk of cardiovascular disease and assess their probabilities of being diagnosed, treated, and controlled, according to their gender, socio-economic status, and urban/rural residence in each country. We will seek plausible explanations for observed differences, drawing on the literature on access to care and adherence and treatment (including two systematic reviews we have recently completed), as well as research on the roles of gender, rurality, and socio-economic inequalities. In particular we will look at characteristics of the health systems, such as co-payments, price and availability of drugs, and wider characteristics of societies, such as gender empowerment. The project has strong links to policy through global and national professional organisations, thereby increasing the potential for the findings to inform global debates and will be translated into action within countries. It explicitly addresses two of the three of the ESRC's strategic priorities (and their components): how to understand behaviour and risks at multiple levels and a variety of contexts (especially on public and preventative health) and a vibrant and fair society (including internationally and by exploiting data from ongoing longitudinal studies).

中低收入国家的疾病负担正在发生变化，需要长期治疗的慢性病越来越多。然而，现有的证据（主要是关于急性病的证据）表明，在获得医疗服务方面存在很大的不平等。该项目的目标是通过结合两个独特的大型数据集（前瞻性城乡流行病学（PURE）个人队列和社区卫生环境概况（EPOCH）社区概况），了解卫生系统在形成低收入、中等收入和高收入国家在获得持续有效的慢性病护理方面的性别、地理和社会经济不平等方面的作用。其中包含来自21个发展水平不同的国家（加拿大、瑞典、沙特阿拉伯、阿拉伯联合酋长国、阿根廷、巴西、智利、波兰、土耳其、马来西亚、南非、中国、哥伦比亚、伊朗、巴勒斯坦、菲律宾、孟加拉国、印度、巴基斯坦、坦桑尼亚、津巴布韦）600多个社区的17万多名35-70岁人群的个人数据，包括他们的社会经济特征、临床参数（如血压、心电图、血液、尿液）、治疗、卫生保健的利用情况和结果，到目前为止进行了3年的跟踪调查，以及他们所居住社区的概况，包括卫生设施和药品的可得性和价格。我们将根据每个国家的性别、社会经济地位和城市/农村居住情况，确定那些患有或有心血管疾病风险的人，并评估他们被诊断、治疗和控制的可能性。我们将利用关于获得护理和坚持治疗的文献（包括我们最近完成的两项系统综述），以及关于性别、农村性和社会经济不平等的作用的研究，为观察到的差异寻求合理的解释。我们将特别关注卫生系统的特点，如共同支付、药品的价格和可得性，以及更广泛的社会特点，如性别赋权。该项目通过全球和国家专业组织与政策建立了紧密的联系，从而增加了研究结果为全球辩论提供信息并在各国转化为行动的可能性。它明确地处理了经济、社会和文化委员会的三个战略优先事项（及其组成部分）中的两个：如何在多个层面和各种情况下理解行为和风险（特别是在公共和预防性卫生方面）以及一个充满活力和公平的社会（包括在国际上和利用正在进行的纵向研究的数据）。

项目成果

Additional file 9: Figure S3. of 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

附加文件 9：图 S3。

• DOI: 10.6084/m9.figshare.c.3626129_d5
• 发表时间: 2016
• 作者: Palafox B

Additional file 3 of 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

附加文件 3 财富与心血管健康：高、中、低收入国家高血压认识、治疗和控制方面与财富相关的不平等的横断面研究

• DOI: 10.6084/m9.figshare.c.3626129_d9
• 发表时间: 2016
• 作者: Palafox B

Additional file 10: of 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

附加文件 10：财富与心血管健康：高、中、低收入国家高血压认识、治疗和控制方面与财富相关的不平等的横断面研究

• DOI: 10.6084/m9.figshare.c.3626129_d2
• 发表时间: 2016
• 作者: Palafox B

Additional file 2: of 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

附加文件 2：财富与心血管健康：高、中、低收入国家高血压认识、治疗和控制方面与财富相关的不平等的横断面研究

• DOI: 10.6084/m9.figshare.c.3626129_d3
• 发表时间: 2016
• 作者: Palafox B

Does greater individual social capital improve the management of hypertension? Cross-national analysis of 61 229 individuals in 21 countries.

• DOI: 10.1136/bmjgh-2017-000443
• 发表时间: 2017
• 期刊: BMJ global health
• 影响因子: 8.1
• 作者: Palafox B;Goryakin Y;Stuckler D;Suhrcke M;Balabanova D;Alhabib KF;Avezum A;Bahonar A;Bai X;Chifamba J;Dans AL;Diaz R;Gupta R;Iqbal R;Ismail N;Kaur M;Keskinler MV;Khatib R;Kruger A;Kruger IM;Lanas F;Lear SA;Li W;Liu J;Lopez-Jaramillo P;Peer N;Poirier P;Rahman O;Pillai RK;Rangarajan S;Rosengren A;Swaminathan S;Szuba A;Teo K;Wang Y;Wielgosz A;Yeates KE;Yusufali A;Yusuf S;McKee M
• 通讯作者: McKee M