Reducing cardiovascular disease disparities in low- and middle-income countries

A health care worker checks a patient's blood pressure

March 11, 2024 — Stéphane Verguet, associate professor of global health at Harvard T.H. Chan School of Public Health, develops mathematical and computational decision-making models that can improve the design of health policies. He recently co-authored a study, led by PhD candidate Dorit Stein, with collaborators from around the world that looked at whether equalizing hypertension diagnosis and treatment in low- and middle-income countries (LMICs) could reduce socioeconomic-based cardiovascular disease (CVD) disparities.

Stéphane Verguet
Stéphane Verguet

Q: Why did you decide to focus on this question?

A: CVD is a leading cause of death globally—with the majority of these deaths in LMICs. Hypertension is a major risk factor, but in these countries, there is considerable inequity in diagnosis and treatment across socioeconomic groups.

We wanted to see whether interventions to equalize hypertension management would impact disparities in CVD risk. We didn’t know whether disparities in CVD risk across socioeconomic groups were primarily driven by access to hypertension management, or by other factors. There hasn’t been much research evidence on either the data side or the outcomes modeling side. Our motivation was to fill a gap around a major global disease burden.

Q: What is new and innovative about this study?

A: Two things. First, we used individual-level data from nationally representative, cross-sectional population surveys—nearly 110,000 individuals across 44 countries, a quite impressive set of data inputs. The second thing is that we leveraged these data sets into a model to simulate what it would look like if all socioeconomic groups had access to the same levels of care across all stages of hypertension management—known as the care cascade—from diagnosis to treatment.

We found that equalizing hypertension management could make a significant difference in LMICs. Our findings showed that targeted improvements across the hypertension care cascade could reduce socioeconomic-based disparities in CVD risk. More specifically, we could see that there were greater benefits—defined as CVD cases averted—among the bottom wealth quintiles and in the countries that had larger disparities in the hypertension care cascade to start with. 

Q: What are the public health implications of your findings?

A: Given that the burden of hypertension and associated CVDs is rising, especially in LMICs, targeted interventions are urgently needed to equalize diagnosis and treatment coverage across socioeconomic groups. Through broader adoption of targeted interventions, we may be able to eventually diminish the disparities in CVD. And because CVD is such a major cause of death, reducing disparities can eventually contribute substantially to broader health equity improvements.

Amy Roeder

Photos: iStock / Jacob Wackerhausen; Kent Dayton