Journal Article

Diagnostic testing for hypertension, diabetes, and hypercholesterolaemia in low-income and middle-income countries: a cross-sectional study of data for 994 185 individuals from 57 nationally representative surveys


  • Sophie Ochmann
  • Isabelle von Polenz
  • Maja-Emilia Marcus
  • Michaela Theilmann
  • David Flood
  • Kokou Agoudavi
  • Krishna Kumar Aryal
  • Silver Bahendeka
  • Brice Bicaba
  • Pascal Bovet
  • Luisa Campos Caldeira Brant
  • Deborah Carvalho Malta
  • Albertino Damasceno
  • Farshad Farzadfar
  • Gladwell Gathecha
  • Ali Ghanbari
  • Mongal Gurung
  • David Guwatudde
  • Corine Houehanou
  • Dismand Houinato
  • Nahla Hwalla
  • Jutta Adelin Jorgensen
  • Khem B Karki
  • Nuno Lunet
  • Joao Martins
  • Mary Mayige
  • Sahar Saeedi Moghaddam
  • Omar Mwalim
  • Kibachio Joseph Mwangi
  • Bolormaa Norov
  • Sarah Quesnel-Crooks
  • Negar Rezaei
  • Abla M Sibai
  • Lela Sturua
  • Lindiwe Tsabedze
  • Roy Wong-McClure
  • Justine Davies
  • Pascal Geldsetzer
  • Till Bärnighausen
  • Rifat Atun
  • Jennifer Manne-Goehler
  • Sebastian Vollmer
Publication Date

Background: Testing for the risk factors of cardiovascular disease, which include hypertension, diabetes, and hypercholesterolaemia, is important for timely and effective risk management. Yet few studies have quantified and analysed testing of cardiovascular risk factors in low-income and middle-income countries (LMICs) with respect to sociodemographic inequalities. We aimed to address this knowledge gap.

Methods: In this cross-sectional analysis, we pooled individual-level data for non-pregnant adults aged 18 years or older from nationally representative surveys done between Jan 1, 2010, and Dec 31, 2019 in LMICs that included a question about whether respondents had ever had their blood pressure, glucose, or cholesterol measured. We analysed diagnostic testing performance by quantifying the overall proportion of people who had ever been tested for these cardiovascular risk factors and the proportion of individuals who met the diagnostic testing criteria in the WHO package of essential noncommunicable disease interventions for primary care (PEN) guidelines (ie, a BMI >30 kg/m2 or a BMI >25 kg/m2 among people aged 40 years or older). We disaggregated and compared diagnostic testing performance by sex, wealth quintile, and education using two-sided t tests and multivariable logistic regression models.

Findings: Our sample included data for 994 185 people from 57 surveys. 19·1% (95% CI 18·5–19·8) of the 943 259 people in the hypertension sample met the WHO PEN criteria for diagnostic testing, of whom 78·6% (77·8–79·2) were tested. 23·8% (23·4–24·3) of the 225 707 people in the diabetes sample met the WHO PEN criteria for diagnostic testing, of whom 44·9% (43·7–46·2) were tested. Finally, 27·4% (26·3–28·6) of the 250 573 people in the hypercholesterolaemia sample met the WHO PEN criteria for diagnostic testing, of whom 39·7% (37·1–2·4) 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 least secondary education compared with those with less than primary education.

Interpretation: Our study shows opportunities for health systems in LMICs to improve the targeting of diagnostic testing for cardiovascular risk factors and adherence to diagnostic testing guidelines. Risk-factor-based testing recommendations rather than sociodemographic characteristics should determine which individuals are tested.

Kiel Institute Expert

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