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

中低收入国家的疾病负担正在发生变化，越来越多的慢性病需要长期治疗。然而，现有的证据，主要是关于急性病的证据，表明在获得护理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（前瞻性城市和农村流行病学（PURE）个人队列和社区健康环境概况（EPOCH）社区概况），了解卫生系统在塑造低收入、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。这些数据来自21个处于各种发展水平的国家600多个社区的170 000多名年龄在35-70岁之间的个人（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），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、卫生保健利用和结果，迄今随访3年，以及他们居住的社区概况，包括卫生设施和药品的供应和价格。我们将根据每个国家的性别、社会经济地位和城市/农村居住地，确定患有心血管疾病或有心血管疾病风险的人，并评估他们被诊断、治疗和控制的概率。我们将寻求合理的解释所观察到的差异，利用文献获得护理和坚持和治疗（包括两个系统性评价，我们最近完成），以及性别，农村和社会经济不平等的作用的研究。特别是，我们将研究卫生系统的特点，如共同支付，价格和药物的供应，以及更广泛的社会特点，如妇女赋权。该项目通过全球和国家专业组织与政策建立了密切联系，从而增加了调查结果为全球辩论提供信息并将转化为各国行动的潜力。它明确涉及ESRC三个战略优先事项中的两个（及其组成部分）：如何理解多层次和各种背景下的行为和风险（特别是公共和预防性健康）以及充满活力和公平的社会（包括国际和利用正在进行的纵向研究的数据）。

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).