Socioeconomic Macro-Level Determinants of Hypertension: Ecological Analysis of 138 Low- and Middle-Income Countries

AIM

To assess the relative importance of major socioeconomic determinants of population health on the burden of hypertension in Low-and-Middle-Income Countries (LMICs).

METHODS

Country-level data from 138 countries based on World Development Indicators 2020 were used for correlation and linear regression analyses of eight socioeconomic predictors of hypertension: current health expenditure, domestic general government health expenditure per capita, GDP per capita, adult literacy rate, unemployment rate, urban population, multidimensional poverty index, and total population.

RESULTS

The median prevalence of age-standardised hypertension was 25.8% across the 138 countries, ranging from 13.7% in Peru to 33.4% in Niger. For every 10% increase in the unemployment rate, the prevalence of hypertension increased by 2.70%. For every 10% increase in the percentage of people living in urban areas, hypertension was reduced by 0.63%.

CONCLUSIONS

The findings revealed that countries with high GDP, more investment in health and an improved multidimensional poverty index have a lower prevalence of hypertension.

Relationship analysis between the spread of COVID-19 and the multidimensional poverty index in the city of Manizales, Colombia

COVID-19 has forced government and health agencies to take measures to mitigate the spread of the disease and thus safeguard as many lives as possible. These measures have initially impacted the economy of many countries, and therefore they have been forced to gradually return to a new normalcy, in what they have called reopening. For reopening policies to be effective, it is necessary that the people in charge of drawing up these policies know the local behavior of the propagation of COVID-19, and beyond this they can understand that between the cases of COVID-19 and the socioeconomic conditions of their population there is a relationship. For this reason, in this article a case study is presented, which allowed to evaluate the relationship between positive cases of COVID-19 and the multidimensional poverty index (MPI) in the city of Manizales, Colombia. The results of an exploratory analysis, obtained with the use of remote sensing data, are presented, which allowed to confirm the relationship in mention, and it is hoped that this can serve the municipal administration in its decision making.

Tuberculosis patients with higher levels of poverty face equal or greater costs of illness

SETTING: Fifty-six public clinics in Limpopo Province, South Africa.OBJECTIVE: To evaluate the association between tuberculosis (TB) patient costs and poverty as measured by a multidimensional poverty index.DESIGN: We performed cross-sectional interviews of consecutive patients with TB. TB episode costs were estimated from self-reported income, travel costs, and care-seeking time. Poverty was assessed using the South African Multidimensional Poverty Index (SAMPI) deprivation score (a 12-item household-level index), with higher scores indicating greater poverty. We used multivariable linear regression to adjust for age, sex, human immunodeficiency virus status and travel time.RESULTS: Among 323 participants, 108 (33%) were 'deprived' (deprivation score >0.33). For each 0.1-unit increase in deprivation score, absolute TB episode costs were 1.11 times greater (95%CI 0.97-1.26). TB episode costs were 1.19 times greater with each quintile of higher deprivation score (95%CI 1.00-1.40), but lower by a factor of 0.54 with each quintile of lower self-reported income (higher poverty, 95%CI 0.46-0.62).CONCLUSION: Individuals experiencing multidimensional poverty and the cost of tuberculosis illness in Limpopo, South Africa faced equal or higher costs of TB than non-impoverished patients. Individuals with lower self-reported income experienced higher costs as a proportion of household income but lower absolute costs. Targeted interventions are needed to reduce the economic burden of TB on patients with multidimensional poverty.