Observational studyThe Lancet. Global health2018
Inequalities in the use of secondary prevention of cardiovascular disease by socioeconomic status: evidence from the PURE observational study.
Observational study in The Lancet. Global health, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 53 papers.
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Who cites it
53 citing papers in PubMed, 110 citations in OpenAlex.
- Data Resource Profile: Linking nationwide health and social registries in Estonia (BIG-HEART).International journal of epidemiology · 2026Article
- Social factors, health policy, and environment: implications for cardiovascular disease across the globe.European heart journal · 2025Review
- Article
- Self-Reported Prevalence of Chronic Non-Communicable Diseases Concerning Socioeconomic and Educational Factors: Analysis of the PURE-Ecuador Cohort.Global heart · 2025Article
- Advancements and challenges of adherence to secondary prevention medications among patients with ischemic stroke or transient ischemic attack: the healthcare quality improvement in China, 2007-2018.Therapeutic advances in neurological disorders · 2025Article
- Article
- Household economic burden of type-2 diabetes and hypertension comorbidity care in urban-poor Ghana: a mixed methods study.BMC health services research · 2024Article
- HEARTS in the Americas: Targeting Health System Change to Improve Population Hypertension Control.Current hypertension reports · 2024Review
- Myocardial infarction care in low and high socioeconomic environments: claims data analysis.Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation · 2024Article
- Hypertension care cascades and reducing inequities in cardiovascular disease in low- and middle-income countries.Nature medicine · 2024Article
- Cardiovascular Disease Training Programmes: Three Schemes to Train Leaders for Future Challenges.Global heart · 2024Article
- Relationship between exposure to fine particulate matter and cardiovascular risk factors and the modifying effect of socioeconomic status: a cross-sectional study in Beijing, China.Frontiers in public health · 2024Article
- [HEARTS in the Americas: targeting health system change to improve population hypertension controlHEARTS nas Américas: impulsionar mudanças no sistema de saúde para melhorar o controle da hipertensão arterial na população].Revista panamericana de salud publica = Pan American journal of public health · 2024Article
- Article
- Patient journey for hypertension and dyslipidemia in Saudi Arabia: highlighting the evidence gaps.Archives of public health = Archives belges de sante publique · 2023Article
- Assessing statins use in a real-world primary care digital strategy: a cross-sectional analysis of a population-wide digital health approach.Lancet regional health. Americas · 2023 · on this mapArticle
- Challenges of managing hypertension in Pakistan - a review.Clinical hypertension · 2023Review
- Evaluating the effectiveness of the National Health Insurance Fund in providing financial protection to households with hypertension and diabetes patients in Kenya.International journal for equity in health · 2023Article
- Red Yeast Rice for the Improvement of Lipid Profiles in Mild-to-Moderate Hypercholesterolemia: A Narrative Review.Nutrients · 2023Review
- The burgeoning cardiovascular disease epidemic in Indians - perspectives on contextual factors and potential solutions.The Lancet regional health. Southeast Asia · 2023Review
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Authors and funding
40 authors at 20 institutions in 24 countries.
Funding
Abstract
backgroundThere is little evidence on the use of secondary prevention medicines for cardiovascular disease by socioeconomic groups in countries at different levels of economic development.
methodsWe assessed use of antiplatelet, cholesterol, and blood-pressure-lowering drugs in 8492 individuals with self-reported cardiovascular disease from 21 countries enrolled in the Prospective Urban Rural Epidemiology (PURE) study. Defining one or more drugs as a minimal level of secondary prevention, wealth-related inequality was measured using the Wagstaff concentration index, scaled from -1 (pro-poor) to 1 (pro-rich), standardised by age and sex. Correlations between inequalities and national health-related indicators were estimated.
findingsThe proportion of patients with cardiovascular disease on three medications ranged from 0% in South Africa (95% CI 0-1·7), Tanzania (0-3·6), and Zimbabwe (0-5·1), to 49·3% in Canada (44·4-54·3). Proportions receiving at least one drug varied from 2·0% (95% CI 0·5-6·9) in Tanzania to 91·4% (86·6-94·6) in Sweden. There was significant (p<0·05) pro-rich inequality in Saudi Arabia, China, Colombia, India, Pakistan, and Zimbabwe. Pro-poor distributions were observed in Sweden, Brazil, Chile, Poland, and the occupied Palestinian territory. The strongest predictors of inequality were public expenditure on health and overall use of secondary prevention medicines.
interpretationUse of medication for secondary prevention of cardiovascular disease is alarmingly low. In many countries with the lowest use, pro-rich inequality is greatest. Policies associated with an equal or pro-poor distribution include free medications and community health programmes to support adherence to medications.
fundingFull funding sources listed at the end of the paper (see Acknowledgments).
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