Access to Cardiovascular Disease and Hypertension Medicines in Developing Countries: An Analysis of Essential Medicine Lists, Price, Availability, and Affordability

Husain, Muhammad Jami; Datta, Biplab Kumar; Kostova, Deliana; Joseph, Kristy; Asma, Samira; Richter, Patricia; Jaffe, Marc G.; Kishore, Sandeep P.

doi:10.1161/jaha.119.015302

Cited by 82 publications

(77 citation statements)

References 21 publications

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“…These regional and national differences in total CVD burden and mortality reflect differences in prevalence of CVD risk factors as well as access to health care ( 8 ). Differences in access to effective primary and secondary prevention strategies may also play a role in differences in total CVD burden, especially in low- and middle-income countries (LMICs) ( 9 ).…”

Section: Cardiovascular Diseasesmentioning

confidence: 99%

Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019

Fowkes¹,

Temesgen²,

Mokdad³

et al. 2020

Journal of the American College of Cardiology

6,400

3,191

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Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases.

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Section: Cardiovascular Diseasesmentioning

confidence: 99%

Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019

Fowkes¹,

Temesgen²,

Mokdad³

et al. 2020

Journal of the American College of Cardiology

6,400

3,191

View full text Add to dashboard Cite

show abstract

“…These results imply that the richer areas of the world are more likely to have lower CVD burden than those in poorer territories. It seems this regional diversity in the CVD burden reflects the differences in the awareness about this disease, controlling the potential risk factors, screening programs, availability of proper treatment, as well as the level of patients’ care in different populations [ 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Trend analysis of disability adjusted life years due to cardiovascular diseases: results from the global burden of disease study 2019

et al. 2021

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Background Cardiovascular diseases (CVDs) are the number one cause of global mortality representing about one third of all deaths across the world. The objective of the present study was to model the global trend in disability-adjusted life years (DALY) and its components due to CVD over the past three decades. We also aimed to evaluate the longitudinal relationship between CVD DALY and Human Development Index (HDI) in this period of time. Methods The age-standardized rates of years lost due to disability (YLD), years of life lost (YLL) and DALY were extracted for cardiovascular diseases from the Global Burden of Disease (GBD) Study 2019 in years 1990 to 2019. Additionally, the United Nations Development Programme (UNDP) database was used to retrieve HDI values for all world countries at the same period time. The trend analysis was performed using the joinpoint regression model. Results The obtained revealed a significant downward trend for DALY and its components with the average annual percent change of − 1.0, − 0.3 and − 1.1 per 100,000 population, respectively for DALY, YLD and YLL. We also found that countries with high/very high levels of HDI have remarkably experienced steeper declining slope of trend than those in lower levels of HDI over the study period. Conclusions Although the observed decreasing trend of CVD burden is a hopeful message for all world countries, the considerable gap in slope of trend between richer and poorer parts of the world is a serious alarm for health policy makers. Regarding this, there is an urgent need to put more efforts on implementing preventive programs, improving the level of patients’ care and providing efficient treatment, especially in regions with lower levels of HDI.

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“… 19 In a recent study conducted by Husain et al based on the WHO online repository of national essential medicines lists for 53 countries, the average availability of the essential CVD medications was 54% in LICs and lower-middle-income countries (LMICs) and 60% in HICs and upper-middle-income countries (UMICs). 20 They also found that affordability was lower in LICs and LMICs than HICs and UMICs for both brand and generic medications. 20 In our previous publications from the PURE study, overall hypertension control was worst in LICs and LMICs (10.8%), with poor access to medicines among the reasons for the low frequency of treatment and control of hypertension in these countries.…”

Section: Discussionmentioning

confidence: 99%

“… 20 They also found that affordability was lower in LICs and LMICs than HICs and UMICs for both brand and generic medications. 20 In our previous publications from the PURE study, overall hypertension control was worst in LICs and LMICs (10.8%), with poor access to medicines among the reasons for the low frequency of treatment and control of hypertension in these countries. 6 21 The data in the majority of these studies are now dated, we need repeat assessments to track medication availability and affordability as these could change over time.…”

Section: Discussionmentioning

confidence: 99%

Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries

et al. 2020

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ObjectivesWe 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.MethodsWe 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.ResultsOf 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).ConclusionLower 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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Access to Cardiovascular Disease and Hypertension Medicines in Developing Countries: An Analysis of Essential Medicine Lists, Price, Availability, and Affordability

Cited by 82 publications

References 21 publications

Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019

Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019

Trend analysis of disability adjusted life years due to cardiovascular diseases: results from the global burden of disease study 2019

Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries

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