For people living in extreme poverty, heart disease risk factors more common than thought
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Key takeaways:
- Prevalence of heart disease risk factors ranged from 1.4% to 17.5% in people living in extreme poverty.
- The prevalence is greater than previously believed and may be due to more consumption of unhealthy foods.
People living in extreme poverty had a higher prevalence of heart disease risk factors such as hypertension, diabetes, smoking, obesity and dyslipidemia than previously thought, according to an analysis of people from 78 countries.
The perception that people living in extreme poverty, defined by the World Bank as income of less than $1.90 per day, are unlikely to have heart disease risk factors exists because “historically in low- or middle-income countries, the poor have had less access to calorie-rich/unhealthy food and do more exercise for work or travel, whereas the more wealthy people have become more sedentary and eaten a calorie-rich diet,” Justine Davies, MD, MRCP, MBChB, BMSc, BSc, DipABRSM, professor of global health research at the University of Birmingham, U.K., extraordinary professor at the Centre for Global Surgery, department of global health, Stellenbosch University, Cape Town, South Africa, and professor of public health, Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, faculty of health sciences, University of the Witwatersrand School of Public Health, Johannesburg, told Healio. “But whereas this view has persisted among many health care providers, policymakers and researchers, the circumstances of poorer people have actually changed rapidly, and they are now getting more CVD risk factors due to doing less exercise and eating more unhealthy food than has traditionally been expected. There is also the idea that people who have been traditionally exposed to few calories develop, over generations, a predisposition to ‘hold onto’ calories when they come available, which means that poorer people might be genetically disposed to become overweight/obese and then develop CVD risk factors.”
Davies and colleagues pooled individual-level data from 105 nationally representative household surveys covering 3,269,557 participants from 78 countries, of whom 792,228 were living in extreme poverty, representing 85% of people living in extreme poverty around the world. The results were published in Nature Human Behaviour.
“We used data from countries where there had been national surveys to collect this information — these are difficult and expensive to do, so are not done very often, but there were enough of them done in recent enough times to allow us to do the analysis well,” Davies told Healio. “With measuring poverty levels, there is the additional issue that in many countries people don’t earn set amounts of money — this is especially true of poorer people who often work in the informal sector or on their own land. Nevertheless, the ways that the survey questions were asked allowed us to develop comparable methods of assessing poverty across all countries.”
According to the researchers, the prevalence of the following CVD risk factors in people living in extreme poverty was:
- hypertension, 17.5% (95% CI, 16.7-18.3);
- diabetes, 4% (95% CI, 3.6-4.5);
- smoking, 10.6% (95% CI, 9-12.3);
- obesity, 3.1% (95% CI, 2.8-3.3); and
- dyslipidemia 1.4% (95% CI, 0.9-1.9).
Most participants living in extreme poverty who had CVD risk factors were not treated for them, the researchers wrote. For example, only 15.2% (95% CI, 13.3-17.1) of those with hypertension were taking medication for it.
“We shouldn’t neglect this growing burden of cardiovascular disease risk factors in poor people in low- or middle-income countries,” Davies told Healio. “We have shown that this is an important problem, but because of the persistence of the traditional ideas that poorer people don’t get these conditions, there has not been the investment in health care systems to prevent or management these diseases. With this rising level of cardiovascular risk factors, and no preventive help, many poorer people will suffer cardiovascular disease and be unable to work or support their families. This could be a huge personal and economic issue.”
Davies said the health care community should “invest more in preventive and management services for cardiovascular risk factors and cardiovascular diseases in low- or middle-income countries.”
For more information:
Justine Davies, MD, MRCP, MBChB, BMSc, BSc, DipABRSM, can be reached at j.davies.6@bham.ac.uk; X (Twitter): @drjackoids.
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