Browsing by Author "Krishna K Aryal"

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    Data Resource Profile: The Global Health and Population Project on Access to Care for Cardiometabolic Diseases (HPACC)
    (2022-12-13) Jennifer Manne-Goehler; Michaela Theilmann; David Flood; Maja E Marcus; Glennis Andall-Brereton; Kokou Agoudavi; William Andres Lopez Arboleda; Krishna K Aryal; Brice Bicaba; Pascal Bovet; Luisa Campos Caldeira Brant; Garry Brian; Grace Chamberlin; Geoffrey Chen; Albertino Damasceno; Maria Dorobantu; Matthew Dunn; Cara Ebert; Farshad Farzadfar; Mongal Singh Gurung; David Guwatudde; Corine Houehanou; Dismand Houinato; Nahla Hwalla; Jutta M Adelin Jorgensen; Khem B Karki; Demetre Labadarios; Nuno Lunet; Deborah Carvalho Malta; Joao S Martins; Mary T Mayige; Roy Wong McClure; Sahar Saeedi Moghaddam; Kibachio J Mwangi; Omar Mwalim; Bolormaa Norov; Sarah Quesnel-Crooks; Sabrina Rhode; Jacqueline A Seiglie; Abla Sibai; Bahendeka K Silver; Lela Sturua; Andrew Stokes; Adil Supiyev; Lindiwe Tsabedze; Zhaxybay Zhumadilov; Lindsay M Jaacks; Rifat Atun; Justine I Davies
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    The socioeconomic gradient of alcohol use: an analysis of nationally representative survey data from 55 low-income and middle-income countries
    (2022-10-22) Yuanwei Xu; Pascal Geldsetzer; Jen Manne-Goehler; Michaela Theilmann; Maja-E Marcus; Zhaxybay Zhumadilov; Sarah Quesnel-Crooks; Omar Mwalim; Sahar Saeedi Moghaddam; Sogol Koolaji; Khem B Karki; Farshad Farzadfar; Narges Ebrahimi; Albertino Damasceno; Krishna K Aryal; Kokou Agoudavi; Rifat Atun; Till Bärnighausen; Justine Davies; Lindsay M Jaacks; Sebastian Vollmer; Charlotte Probst
    Background: Alcohol is a leading risk factor for over 200 conditions and an important contributor to socioeconomic health inequalities. However, little is known about the associations between individuals' socioeconomic circumstances and alcohol consumption, especially heavy episodic drinking (HED; ≥5 drinks on one occasion) in low-income or middle-income countries. We investigated the association between individual and household level socioeconomic status, and alcohol drinking habits in these settings. Methods: In this pooled analysis of individual-level data, we used available nationally representative surveys-mainly WHO Stepwise Approach to Surveillance surveys-conducted in 55 low-income and middle-income countries between 2005 and 2017 reporting on alcohol use. Surveys from participants aged 15 years or older were included. Logistic regression models controlling for age, country, and survey year stratified by sex and country income groups were used to investigate associations between two indicators of socioeconomic status (individual educational attainment and household wealth) and alcohol use (current drinking and HED amongst current drinkers). Findings: Surveys from 336 287 participants were included in the analysis. Among males, the highest prevalence of both current drinking and HED was found in lower-middle-income countries (L-MICs; current drinking 49·9% [95% CI 48·7-51·2] and HED 63·3% [61·0-65·7]). Among females, the prevalence of current drinking was highest in upper-middle-income countries (U-MIC; 29·5% [26·1-33·2]), and the prevalence of HED was highest in low-income countries (LICs; 36·8% [33·6-40·2]). Clear gradients in the prevalence of current drinking were observed across all country income groups, with a higher prevalence among participants with high socioeconomic status. However, in U-MICs, current drinkers with low socioeconomic status were more likely to engage in HED than participants with high socioeconomic status; the opposite was observed in LICs, and no association between socioeconomic status and HED was found in L-MICs. Interpretation: The findings call for urgent alcohol control policies and interventions in LICs and L-MICs to reduce harmful HED. Moreover, alcohol control policies need to be targeted at socially disadvantaged groups in U-MICs. Funding: Deutsche Forschungsgemeinschaft and the National Center for Advancing Translational Sciences of the US National Institutes of Health.
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    Use of statins for the prevention of cardiovascular disease in 41 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data
    (2022-03) Maja E Marcus; Jennifer Manne-Goehler; Michaela Theilmann; Farshad Farzadfar; Sahar Saeedi Moghaddam; Mohammad Keykhaei; Amirali Hajebi; Scott Tschida; Julia M Lemp; Krishna K Aryal; Matthew Dunn; Corine Houehanou; Silver Bahendeka; Peter Rohloff; Rifat Atun; Till W Bärnighausen; Pascal Geldsetzer; Manuel Ramirez-Zea; Vineet Chopra; Michele Heisler; Justine I Davies; Mark D Huffman; Sebastian Vollmer; David Flood
    Background: In the prevention of cardiovascular disease, a WHO target is that at least 50% of eligible people use statins. Robust evidence is needed to monitor progress towards this target in low-income and middle-income countries (LMICs), where most cardiovascular disease deaths occur. The objectives of this study were to benchmark statin use in LMICs and to investigate country-level and individual-level characteristics associated with statin use. Methods: We did a cross-sectional analysis of pooled, individual-level data from nationally representative health surveys done in 41 LMICs between 2013 and 2019. Our sample consisted of non-pregnant adults aged 40-69 years. We prioritised WHO Stepwise Approach to Surveillance (STEPS) surveys because these are WHO's recommended method for population monitoring of non-communicable disease targets. For countries in which no STEPS survey was available, a systematic search was done to identify other surveys. We included surveys that were done in an LMIC as classified by the World Bank in the survey year; were done in 2013 or later; were nationally representative; had individual-level data available; and asked questions on statin use and previous history of cardiovascular disease. Primary outcomes were the proportion of eligible individuals self-reporting use of statins for the primary and secondary prevention of cardiovascular disease. Eligibility for statin therapy for primary prevention was defined among individuals with a history of diagnosed diabetes or a 10-year cardiovascular disease risk of at least 20%. Eligibility for statin therapy for secondary prevention was defined among individuals with a history of self-reported cardiovascular disease. At the country level, we estimated statin use by per-capita health spending, per-capita income, burden of cardiovascular diseases, and commitment to non-communicable disease policy. At the individual level, we used modified Poisson regression models to assess statin use alongside individual-level characteristics of age, sex, education, and rural versus urban residence. Countries were weighted in proportion to their population size in pooled analyses. Findings: The final pooled sample included 116 449 non-pregnant individuals. 9229 individuals reported a previous history of cardiovascular disease (7·9% [95% CI 7·4-8·3] of the population-weighted sample). Among those without a previous history of cardiovascular disease, 8453 were eligible for a statin for primary prevention of cardiovascular disease (9·7% [95% CI 9·3-10·1] of the population-weighted sample). For primary prevention of cardiovascular disease, statin use was 8·0% (95% CI 6·9-9·3) and for secondary prevention statin use was 21·9% (20·0-24·0). The WHO target that at least 50% of eligible individuals receive statin therapy to prevent cardiovascular disease was achieved by no region or income group. Statin use was less common in countries with lower health spending. At the individual level, there was generally higher statin use among women (primary prevention only, risk ratio [RR] 1·83 [95% CI 1·22-2·76), and individuals who were older (primary prevention, 60-69 years, RR 1·86 [1·04-3·33]; secondary prevention, 50-59 years RR 1·71 [1·35-2·18]; and 60-69 years RR 2·09 [1·65-2·65]), more educated (primary prevention, RR 1·61 [1·09-2·37]; secondary prevention, RR 1·28 [0·97-1·69]), and lived in urban areas (secondary prevention only, RR 0·82 [0·66-1·00]). Interpretation: In a diverse sample of LMICs, statins are used by about one in ten eligible people for the primary prevention of cardiovascular diseases and one in five eligible people for secondary prevention. There is an urgent need to scale up statin use in LMICs to achieve WHO targets. Policies and programmes that facilitate implementation of statins into primary health systems in these settings should be investigated for the future.