Income, not risk factors, drives global testing disparities for hypertension, diabetes
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Key takeaways:
- Many people living in low- and middle-income countries are not tested for diabetes, hypertension or high cholesterol despite risk factors.
- Income and education level were associated with likelihood of testing.
Diagnostic testing for hypertension, diabetes and hypercholesterolemia remains low globally, driven by substantial shares of low- and middle-income populations who are not tested despite meeting WHO criteria.
“Diagnostic testing availability should not depend on income or education but should be determined by evidence-based criteria and guidelines,” Sophie Ochmann, MSc, a doctoral candidate in the department of economics at the University of Göttingen, Germany, and Isabelle von Polenz, MSc, a medical student at the University of Göttingen and public health researcher at LMU University Munich, told Healio. “In our study population, we found some disparities that should be addressed by public health systems. Hypertension, diabetes and hypercholesterolemia are three major CVD risk factors. Diagnostic testing of BP, blood glucose and lipids is important for identifying patients with these conditions, thereby allowing early treatment or prevention of CVDs.”
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In a cross-sectional analysis, Ochmann, von Polenz and colleagues analyzed pooled individual-level data for 994,185 adults from 57 nationally representative surveys conducted from 2010 to 2019 across low- and middle-income countries that included a question about whether respondents had ever had their BP, glucose or cholesterol measured. Researchers analyzed diagnostic testing performance by quantifying the overall proportion of people who had ever been tested for those three CV risk factors and the proportion of people who met diagnostic testing criteria in the WHO package of essential noncommunicable disease interventions for primary care (PEN) guidelines, such as elevated BMI among people aged 40 years or older.
The findings were published in The Lancet Global Health.
Researchers found that 19.1% of the 943,259 people in the hypertension sample met WHO PEN criteria for diagnostic testing, of whom 78.6% were tested; 23.8% of the 225,707 people in the diabetes sample met WHO PEN criteria, of whom 44.9% were tested; and 27.4% of the 250,573 people in the hypercholesterolemia sample met WHO PEN criteria, of whom 39.7% were tested.
Women were more likely than men to be tested for hypertension and diabetes, and people in higher wealth quintiles compared with those in the lowest wealth quintile were more likely to be tested for all three risk factors, as were people with at a least secondary education compared with those with less than primary education.
“We find adherence to testing guidelines to be low. ... This is driven by substantial shares of individuals being tested despite not meeting the WHO PEN testing criteria,” Ochmann and von Polenz told Healio. “At the same time, we find substantial shares to not have their blood glucose (11.5%) or cholesterol (13.5%) tested despite meeting the WHO PEN testing criteria.”
Ochmann and von Polenz noted that testing for CVD risk should be based on risk factors.
“It is important to identify CVDs at an early stage, but also to ensure careful use of expensive resources,” Ochmann and von Polenz told Healio. “The use of more costly diagnostic tests (eg, laboratory tests) therefore requires careful consideration and should not be based on the patients’ socioeconomic characteristics. Across the Global South, there are still a significant number of people who fulfill the diagnostic testing criteria of the WHO PEN guidelines which remain untested for hypertension, diabetes and hypercholesterolemia.”
The researchers said as more WHO STEPS surveys become available, studies could gauge improvements in low- and middle-income countries’ diagnostic testing performance over time.
For more information:
Sophie Ochmann, MSc, can be reached at sophie.ochmann@uni-goettingen.de; X (Twitter): @sophie_ochmann.
Isabelle von Polenz, MSc, can be reached on X (Twitter) at @isabellevp.
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