Examinando por Autor "Orlandini, Andres"

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    Association of dairy consumption with metabolic syndrome, hypertension and diabetes in 147 812 individuals from 21 countries
    (BMJ Journals, 2020-05-18) Bhavadharini, Balaji; Dehghan, Mahshid; Mente, Andrew; Rangarajan, Sumathy; Sheridan, Patrick; Mohan, Viswanathan; Iqbal, Romaina; Gupta, Rajeev; Lear, Scott; Wentzel-Viljoen, Edelweiss; Avezum, Alvaro; Lopez-Jaramillo, Patricio; Mony, Prem; Prasad Varma, Ravi; Kumar, Rajesh; Chifamba, Jephat; Alhabib, Khalid F; Mohammadifard, Noushin; Oguz, Aytekin; Lanas, Fernando; Rozanska, Dorota; Bengtsson Bostrom, Kristina; Yusoff, Khalid; Tsolkile, Lungiswa P; Dans, Antonio; Yusufali, Afzalhussein; Orlandini, Andres; Poirier, Paul; Khatib, Rasha; Hu, Bo; Wei, Li; Yin, Lu; Deeraili, Ai; Yeates, Karen; Yusuf, Rita; Ismail, Noorhassim; Mozaffarian, Dariush; Teo, Koon; Anand, Sonia S; Yusuf, Salim; Everest
    Objective Our aims were to assess the association of dairy intake with prevalence of metabolic syndrome (MetS) (cross-sectionally) and with incident hypertension and incident diabetes (prospectively) in a large multinational cohort study. Methods The Prospective Urban Rural Epidemiology (PURE) study is a prospective epidemiological study of individuals aged 35 and 70 years from 21 countries on five continents, with a median follow-up of 9.1 years. In the cross-sectional analyses, we assessed the association of dairy intake with prevalent MetS and its components among individuals with information on the five MetS components (n=112 922). For the prospective analyses, we examined the association of dairy with incident hypertension (in 57 547 individuals free of hypertension) and diabetes (in 131 481 individuals free of diabetes). Results In cross-sectional analysis, higher intake of total dairy (at least two servings/day compared with zero intake; OR 0.76, 95% CI 0.71 to 0.80, p-trend<0.0001) was associated with a lower prevalence of MetS after multivariable adjustment. Higher intakes of whole fat dairy consumed alone (OR 0.72, 95% CI 0.66 to 0.78, p-trend<0.0001), or consumed jointly with low fat dairy (OR 0.89, 95% CI 0.80 to 0.98, p-trend=0.0005), were associated with a lower MetS prevalence. Low fat dairy consumed alone was not associated with MetS (OR 1.03, 95% CI 0.77 to 1.38, p-trend=0.13). In prospective analysis, 13 640 people with incident hypertension and 5351 people with incident diabetes were recorded. Higher intake of total dairy (at least two servings/day vs zero serving/day) was associated with a lower incidence of hypertension (HR 0.89, 95% CI 0.82 to 0.97, p-trend=0.02) and diabetes (HR 0.88, 95% CI 0.76 to 1.02, p-trend=0.01). Directionally similar associations were found for whole fat dairy versus each outcome. Conclusions Higher intake of whole fat (but not low fat) dairy was associated with a lower prevalence of MetS and most of its component factors, and with a lower incidence of hypertension and diabetes. Our findings should be evaluated in large randomized trials of the effects of whole fat dairy on the risks of MetS, hypertension, and diabetes.
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    Association of dairy intake with cardiovascular disease and mortality in 21 countries from five continents (PURE) : A prospective cohort study
    (2018-09-11) Dehghan, Mahshid; Mente, Andrew; Rangarajan, Sumathy; Sheridan, Patrick; Mohan, Viswanathan; Iqbal, Romaina; Gupta, Rajeev; Lear, Scott A.; Wentzel Viljoen, Edelweiss; Avezum, Alvaro; Lopez-Jaramillo, Patricio; Mony, Prem; Varma, Ravi Prasad; Kumar, Rajesh; Chifamba, Jephat; AlHabib, Khalid F.; Mohammadifard, Noushin; Oguz, Aytekin; Lanas, Fernando; Rozanska, Dorota; Bengtsson Bostrom, Kristina; Yusoff, Khalid; Tsolekile, Lungiswa P.; Dans, Antonio; Yusufali, Afzalhussein; Orlandini, Andres; Poirier, Paul P.; Khatib, Rasha; Hu, Bo; Wei, Li; Yin, Lu; Deeraili, Ai; Yeates, Karen; Yusuf, Rita; Ismail, Noorhassim; Mozaffarian, Dariush; Teo, Koon; Anand, Sonia S.; Yusuf, Salim; Prospective Urban Rural Epidemiology (PURE), Study investigators
    Background Dietary guidelines recommend minimising consumption of whole-fat dairy products, as they are a source of saturated fats and presumed to adversely affect blood lipids and increase cardiovascular disease and mortality. Evidence for this contention is sparse and few data for the effects of dairy consumption on health are available from low-income and middle-income countries. Therefore, we aimed to assess the associations between total dairy and specific types of dairy products with mortality and major cardiovascular disease. Methods The Prospective Urban Rural Epidemiology (PURE) study is a large multinational cohort study of individuals aged 35–70 years enrolled from 21 countries in five continents. Dietary intakes of dairy products for 136 384 individuals were recorded using country-specific validated food frequency questionnaires. Dairy products comprised milk, yoghurt, and cheese. We further grouped these foods into whole-fat and low-fat dairy. The primary outcome was the composite of mortality or major cardiovascular events (defined as death from cardiovascular causes, non-fatal myocardial infarction, stroke, or heart failure). Hazard ratios (HRs) were calculated using multivariable Cox frailty models with random intercepts to account for clustering of participants by centre. Findings Between Jan 1, 2003, and July 14, 2018, we recorded 10 567 composite events (deaths [n=6796] or major cardiovascular events [n=5855]) during the 9·1 years of follow-up. Higher intake of total dairy (>2 servings per day compared with no intake) was associated with a lower risk of the composite outcome (HR 0·84, 95% CI 0·75–0·94; ptrend=0·0004), total mortality (0·83, 0·72–0·96; ptrend=0·0052), non-cardiovascular mortality (0·86, 0·72–1·02; ptrend=0·046), cardiovascular mortality (0·77, 0·58–1·01; ptrend=0·029), major cardiovascular disease (0·78, 0·67–0·90; ptrend=0·0001), and stroke (0·66, 0·53–0·82; ptrend=0·0003). No significant association with myocardial infarction was observed (HR 0·89, 95% CI 0·71–1·11; ptrend=0·163). Higher intake (>1 serving vs no intake) of milk (HR 0·90, 95% CI 0·82–0·99; ptrend=0·0529) and yogurt (0·86, 0·75–0·99; ptrend=0·0051) was associated with lower risk of the composite outcome, whereas cheese intake was not significantly associated with the composite outcome (0·88, 0·76–1·02; ptrend=0·1399). Butter intake was low and was not significantly associated with clinical outcomes (HR 1·09, 95% CI 0·90–1·33; ptrend=0·4113). Interpretation Dairy consumption was associated with lower risk of mortality and major cardiovascular disease events in a diverse multinational cohort. Funding Full funding sources are listed at the end of the paper (see Acknowledgments).
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    Association of estimated sleep duration and naps with mortality and cardiovascular events
    (European Society of Cardiology, 2019-05-21) Wang, Chuangshi; Bangdiwala, Shrikant I.; Rangarajan, Sumathy; Lear, Scott A.; AlHabib, Khalid F.; Mohan, Viswanathan; Koon, Teo; Poirier, Paul; Tse, Lap Ah; Liu, Zhiguang; Rosengren, Annika; Kumar, Rajesh; Lopez-Jaramillo, Patricio; Yusoff, Khalid; Monsef, Nahed; Krishnapillai, Vijayakumar; Ismail, Noorhassim; Seron, Pamela; Dans, Antonio; Kruger, Lanthé; Yeates, Karen; Leach, Lloyd; Yusuf, Rita; Orlandini, Andres; Wolyniec, Maria; Bahonar, Ahmad; Mohan, Indu; Khatib, Rasha; Temizhan, Ahmet; Li, Wei; Yusuf, Salim; On behalf of the Prospective Urban Rural Epidemiology (PURE) study investigators; Everest
    Aims To investigate the association of estimated total daily sleep duration and daytime nap duration with deaths and major cardiovascular events. Methods and results We estimated the durations of total daily sleep and daytime naps based on the amount of time in bed and self-reported napping time and examined the associations between them and the composite outcome of deaths and major cardiovascular events in 116 632 participants from seven regions. After a median follow-up of 7.8 years, we recorded 4381 deaths and 4365 major cardiovascular events. It showed both shorter (≤6 h/day) and longer (>8 h/day) estimated total sleep durations were associated with an increased risk of the composite outcome when adjusted for age and sex. After adjustment for demographic characteristics, lifestyle behaviours and health status, a J-shaped association was observed. Compared with sleeping 6–8 h/day, those who slept ≤6 h/day had a non-significant trend for increased risk of the composite outcome [hazard ratio (HR), 1.09; 95% confidence interval, 0.99–1.20]. As estimated sleep duration increased, we also noticed a significant trend for a greater risk of the composite outcome [HR of 1.05 (0.99–1.12), 1.17 (1.09–1.25), and 1.41 (1.30–1.53) for 8–9 h/day, 9–10 h/day, and >10 h/day, Ptrend < 0.0001, respectively]. The results were similar for each of all-cause mortality and major cardiovascular events. Daytime nap duration was associated with an increased risk of the composite events in those with over 6 h of nocturnal sleep duration, but not in shorter nocturnal sleepers (≤6 h). Conclusion Estimated total sleep duration of 6–8 h per day is associated with the lowest risk of deaths and major cardiovascular events. Daytime napping is associated with increased risks of major cardiovascular events and deaths in those with >6 h of nighttime sleep but not in those sleeping ≤6 h/night.
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    Association of ultra-processed food intake with risk of inflammatory bowel disease. Prospective cohort study
    (BMJ Journals, 2021-07-14) Narula, Neeraj; Wong, Emily C.L.; Dehghan, Mahshid; Mente, Andrew; Rangarajan, Sumathy; Lanas, Fernando; Lopez-Jaramillo, Patricio; Rohatgi, Priyanka; Lakshmi, P. V. M.; Prasad Varma, Ravi; Orlandini, Andres; Avezum, Alvaro; Wielgosz, Andreas; Poirier, Paul; Almadi, Majid A.; Altuntas, Yuksel; Ng, Kien Keat; Chifamba, Jephat; Yeates, Karen; Puoane, Thandi; Khatib, Rasha; Yusuf, Rita; Bengtsson Boström, Kristina; Zatonska, Katarzyna; Iqbal, Romaina; Weida, Liu; Yibing, Zhu; Sidong, Li; Dans, Antonio; Yusufali, Afzalhussein; Mohammadifard, Noushin; Marshall, John K.; Moayyedi, Paul; Reinisch, Walter; Yusuf, Salim; Masira
    OBJECTIVE To evaluate the relation between intake of ultraprocessed food and risk of inflammatory bowel disease (IBD). DESIGN Prospective cohort study. SETTING 21 low, middle, and high income countries across seven geographical regions (Europe and North America, South America, Africa, Middle East, south Asia, South East Asia, and China). PARTICIPANTS 116087 adults aged 35-70 years with at least one cycle of follow-up and complete baseline food frequency questionnaire (FFQ) data (country specific validated FFQs were used to document baseline dietary intake). Participants were followed prospectively at least every three years. MAIN OUTCOME MEASURES The main outcome was development of IBD, including Crohn’s disease or ulcerative colitis. Associations between ultra-processed food intake and risk of IBD were assessed using Cox proportional hazard multivariable models. Results are presented as hazard ratios with 95% confidence intervals. RESULTS Participants were enrolled in the study between 2003 and 2016. During the median follow-up of 9.7 years (interquartile range 8.9-11.2 years), 467 participants developed incident IBD (90 with Crohn’s disease and 377 with ulcerative colitis). After adjustment for potential confounding factors, higher intake of ultra-processed food was associated with a higher risk of incident IBD (hazard ratio 1.82, 95% confidence interval 1.22 to 2.72 for ≥5 servings/day and 1.67, 1.18 to 2.37 for 1-4 servings/day compared with <1 serving/day, P=0.006 for trend). Different subgroups of ultra-processed food, including soft drinks, refined sweetened foods, salty snacks, and processed meat, each were associated with higher hazard ratios for IBD. Results were consistent for Crohn’s disease and ulcerative colitis with low heterogeneity. Intakes of white meat, red meat, dairy, starch, and fruit, vegetables, and legumes were not associated with incident IBD. CONCLUSIONS Higher intake of ultra-processed food was positively associated with risk of IBD. Further studies are needed to identify the contributory factors within ultraprocessed foods. STUDY REGISTRATION ClinicalTrials.gov NCT03225586.
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    Association of urinary sodium excretion with blood pressure and cardiovascular clinical events in 17,033 Latin americans
    (2016-07) Lamelas, Pablo M.; Mente, Andrew; Diaz, Rafael; Orlandini, Andres; Avezum, Alvaro; Oliveira, Gustavo; Lanas, Fernando; Seron, Pamela; Lopez-Jaramillo, Patricio; Camacho López, Paul Anthony; O’Donnell, Martin J.; Rangarajan, Sumathy; Teo, Koon; Yusuf, Salim
    BACKGROUND: Information on actual sodium intake and its relationships with blood pressure (BP) and clinical events in South America is limited. The aim of this cohort study was to assess the relationship of sodium intake with BP, cardiovascular (CV) events, and mortality in South America. METHODS: We studied 17,033 individuals, aged 35–70 years, from 4 South American countries (Argentina, Brazil, Chile, and Colombia). Measures of sodium excretion, estimated from morning fasting urine, were used as a surrogate for daily sodium intake. We measured BP and monitored the composite outcome of death and major CV events. RESULTS: Overall mean sodium excretion was 4.70±1.43g/day. A positive, nonuniform association between sodium and BP was detected, with a significant steeper slope for the relationship at higher sodium excretion levels ( P < 0.001 for interaction). With a median follow-up of 4.7 years, the primary composite outcome (all-cause death, myocardial infarction, stroke, or heart failure) occurred in 568 participants (3.4%). Compared with sodium excretion of 5–6g/day (reference group), participants who excreted >7g/day had increased risks of the primary outcome (odds ratio (OR) 1.73; 95% confidence interval (CI) 1.24 to 2.40; P < 0.001), as well as death from any cause (OR 1.87; 95% CI 1.23 to 2.83; P = 0.003) and major CV disease (OR 1.77; 95% CI 1.12 to 2.81; P = 0.014). Sodium excretion of <3g/day was associated with a statistically nonsignificant increased risk of the primary outcome (OR 1.20; 95% CI 0.86 to 1.65; P = 0.26) and death from any cause (OR 1.25; 95% CI 0.81 to 1.93; P = 0.29), and a significant increased risk of major CV disease (OR 1.50; 95% CI 1.01 to 2.24; P = 0.048), as compared to the reference group. CONCLUSIONS: Our results support a positive, nonuniform association between estimated urinary sodium excretion and BP, and a possible J-shaped pattern of association between sodium excretion over the entire range and clinical outcomes.
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    Availability, affordability, and consumption of fruits and vegetables in 18 countries across income levels : Findings from the Prospective Urban Rural Epidemiology (PURE) study
    (2016-08-23) Lopez-Jaramillo, Patricio; Mente, Andrew; Teo, Koon; Xiulin, Bai; Xu, Liu; Hui, Chen; Jian, Bo; Wei, Li; Poirier, Paul P.; Zatonska, Katarzyna; Ariffin, Farnaza; Martinez Oakley, Solange; Chifamba, Jephat; Iqbal, Romaina; Karsidag, Kubilay; Yusufali, Afzalhussein; Ismail, Noorhassim; Orlandini, Andres; Avezum, Alvaro; Rosengren, Annika; Rahman, Omar; Mohammadifard, Noushin; Tsolekile, Lungiswa P.; Kruger, Annamarie; Gupta, Rajeev; Vijayakumar, Krishnapillai; Mohan, Viswanathan; Kaur, Manmeet; Mony, Prem; Lear, Scott A.; Khatib, Rasha; Rangarajan, Sumathy; Popkin, Barry; Lock, Karen; Corsi, Daniel J.; Dehghan, Mahshid; Chow, Clara K.; Yusuf, Salim; Miller, Victoria
    Background Several international guidelines recommend the consumption of two servings of fruits and three servings of vegetables per day, but their intake is thought to be low worldwide. We aimed to determine the extent to which such low intake is related to availability and aff ordability. Methods We assessed fruit and vegetable consumption using data from country-specific, validated semi-quantitative food frequency questionnaires in the Prospective Urban Rural Epidemiology (PURE) study, which enrolled participants from communities in 18 countries between Jan 1, 2003, and Dec 31, 2013. We documented household income data from participants in these communities; we also recorded the diversity and non-sale prices of fruits and vegetables from grocery stores and market places between Jan 1, 2009, and Dec 31, 2013. We determined the cost of fruits and vegetables relative to income per household member. Linear random eff ects models, adjusting for the clustering of households within communities, were used to assess mean fruit and vegetable intake by their relative cost. Findings Of 143 305 participants who reported plausible energy intake in the food frequency questionnaire, mean fruit and vegetable intake was 3·76 servings (95% CI 3·66–3·86) per day. Mean daily consumption was 2·14 servings (1·93–2·36) in low-income countries (LICs), 3·17 servings (2·99–3·35) in lower-middle-income countries (LMICs), 4·31 servings (4·09–4·53) in upper-middle-income countries (UMICs), and 5·42 servings (5·13–5·71) in highincome countries (HICs). In 130 402 participants who had household income data available, the cost of two servings of fruits and three servings of vegetables per day per individual accounted for 51·97% (95% CI 46·06–57·88) of household income in LICs, 18·10% (14·53–21·68) in LMICs, 15·87% (11·51–20·23) in UMICs, and 1·85% (–3·90 to 7·59) in HICs (ptrend=0·0001). In all regions, a higher percentage of income to meet the guidelines was required in rural areas than in urban areas (p<0·0001 for each pairwise comparison). Fruit and vegetable consumption among individuals decreased as the relative cost increased ptrend=0·00040). Interpretation The consumption of fruit and vegetables is low worldwide, particularly in LICs, and this is associated with low aff ordability. Policies worldwide should enhance the availability and aff ordability of fruits and vegetables. Funding Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, AstraZeneca (Canada), Sanofi -Aventis (France and Canada), Boehringer Ingelheim (Germany and Canada), Servier, GlaxoSmithKline, Novartis, King Pharma, and national or local organisations in participating countries.
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    Global mortality variations in patients with heart failure : Results from the International Congestive Heart Failure (INTER-CHF) prospective cohort study
    (2017-07-01) Lopez-Jaramillo, Patricio; Dokainish, Hisham; Teo, Koon; Zhu, Jun; Roy, Ambuj; AlHabib, Khalid F.; ElSayed, Ahmed; Palileo Villaneuva, Lia; Karaye, Kamilu; Yusoff, Khalid; Orlandini, Andres; Sliwa, Karen; Mondo, Charles; Lanas, Fernando; Prabhakaran, Dorairaj; Badr, Amr; Elmaghawry, Mohamed; Damasceno, Albertino; Tibazarwa, Kemi; Belley Cote, Emilie; Balasubramanian, Kumar; Islam, Shofiqul; Yacoub, Magdi H.; Huffman, Mark D.; Harkness, Karen; Grinvalds, Alex; McKelvie, Robert; Bangdiwala, Shrikant I.; Yusuf, Salim; On behalf of the INTER-CHF Investigators.
    Background Most data on mortality and prognostic factors in patients with heart failure come from North America and Europe, with little information from other regions. Here, in the International Congestive Heart Failure (INTERCHF) study, we aimed to measure mortality at 1 year in patients with heart failure in Africa, China, India, the Middle East, southeast Asia and South America; we also explored demographic, clinical, and socioeconomic variables associated with mortality. Methods We enrolled consecutive patients with heart failure (3695 [66%] clinic outpatients, 2105 [34%] hospital in patients) from 108 centres in six geographical regions. We recorded baseline demographic and clinical characteristics and followed up patients at 6 months and 1 year from enrolment to record symptoms, medications, and outcomes. Time to death was studied with Cox proportional hazards models adjusted for demographic and clinical variables, medications, socioeconomic variables, and region. We used the explained risk statistic to calculate the relative contribution of each level of adjustment to the risk of death. Findings We enrolled 5823 patients within 1 year (with 98% follow-up). Overall mortality was 16·5%: highest in Africa (34%) and India (23%), intermediate in southeast Asia (15%), and lowest in China (7%), South America (9%), and the Middle East (9%). Regional differences persisted after multivariable adjustment. Independent predictors of mortality included cardiac variables (New York Heart Association Functional Class III or IV, previous admission for heart failure, and valve disease) and non-cardiac variables (body-mass index, chronic kidney disease, and chronic obstructive pulmonary disease). 46% of mortality risk was explained by multivariable modelling with these variables; however, the remainder was unexplained. Interpretation Marked regional differences in mortality in patients with heart failure persisted after multivariable adjustment for cardiac and non-cardiac factors. Therefore, variations in mortality between regions could be the result of health-care infrastructure, quality and access, or environmental and genetic factors. Further studies in large, global cohorts are needed. Funding The study was supported by Novartis.
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    Global variations in the prevalence, treatment, and impact of atrial fibrillation in a multi-national cohort of 153 152 middle-aged individuals
    (Oxford Academic, 2021-06-05) Joseph, Philip; Healey, Jeffrey S.; Raina, Parminder; Connolly, Stuart J.; Ibrahim, Quazi; Gupta, Rajeev; Avezum, Alvaro; Dans, Antonio; Lopez-Jaramillo, Patricio; Yeates, Karen; Teo, Koon; Douma, Reuben; Bahonar, Ahmad; Chifamba, Jephat; Lanas, Fernando; Dagenais, Gilles R.; Lear, Scott; Kumar, Rajesh; Kengne, Andre P.; Keskinler, Mirac; Mohan, Viswanathan; Mony, Prem; Alhabib, Khalid F.; Huisman, Hugo; Iype, Thomas; Zatonska, Katarzyna; Ismail, Rosnah; Kazmi, Khawar; Rosengren, Annika; Rahman, Omar; Yusufali, Afzalhussein; Wei, Li; Orlandini, Andres; Islam, Shofiqul; Rangarajan, Sumathy; Yusuf, Salim; The PURE Investigators; Masira
    Aims To compare the prevalence of electrocardiogram (ECG)-documented atrial fibrillation (or flutter) (AF) across eight regions of the world, and to examine antithrombotic use and clinical outcomes. Methods and results Baseline ECGs were collected in 153 152 middle-aged participants (ages 35–70 years) to document AF in two community-based studies, spanning 20 countries. Medication use and clinical outcome data (mean follow-up of 7.4 years) were available in one cohort. Cross-sectional analyses were performed to document the prevalence of AF and medication use, and associations between AF and clinical events were examined prospectively. Mean age of participants was 52.1 years, and 57.7% were female. Age and sex-standardized prevalence of AF varied 12-fold between regions; with the highest in North America, Europe, China, and Southeast Asia (270–360 cases per 100 000 persons); and lowest in the Middle East, Africa, and South Asia (30–60 cases per 100 000 persons) (P < 0.001). Compared with low-income countries (LICs), AF prevalence was 7-fold higher in middle-income countries (MICs) and 11-fold higher in high-income countries (HICs) (P < 0.001). Differences in AF prevalence remained significant after adjusting for traditional AF risk factors. In LICs/MICs, 24% of participants with AF and a CHADS2 score ≥1 received antithrombotic therapy, compared with 85% in HICs. AF was associated with an increased risk of stroke [hazard ratio (HR) 2.29; 95% confidence interval (CI) 1.49–3.52] and death (HR 2.97; 95% CI 2.25–3.93); with similar rates in different countries grouped by income level. Conclusions Large variations in AF prevalence occur in different regions and countries grouped by income level, but this is only partially explained by traditional AF risk factors. Antithrombotic therapy is infrequently used in poorer countries despite the high risk of stroke associated with AF.
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    Heart Failure in Africa, Asia, the Middle East and South America: The INTER-CHF study
    (2016-02) Dokainish, Hisham; Teo, Koon; Zhu, Jun; Roy, Ambuj; AlHabib, Khalid F.; ElSayed, Ahmed; Palileo Villaneuva, Lia; Lopez-Jaramillo, Patricio; Karaye, Kamilu; Yusoff, Khalid; Orlandini, Andres; Sliwa, Karen; Mondo, Charles; Lanas, Fernando; Prabhakaran, Dorairaj; Badr, Amr; Elmaghawry, Mohamed; Damasceno, Albertino; Tibazarwa, Kemi; Belley Cote, Emilie; Balasubramanian, Kumar; Yacoub, Magdi H.; Huffman, Mark D.; Harkness, Karen; Grinvalds, Alex; McKelvie, Robert; Yusuf, Salim; The INTER-CHF Investigators
    Background There are few data on heart failure (HF) patients from Africa, Asia, the Middle East and South America. Methods INTER-CHF is a prospective study that enrolled HF patients in 108 centers in 16 countries from 2012 to 2014. Consecutive ambulatory or hospitalized adult patients with HF were enrolled. Baseline data were recorded on sociodemographics, clinical characteristics, HF etiology and treatments. Age- and sex-adjusted results are reported. Results We recruited 5813 HF patients: mean(SE) age = 59(0.2) years, 39% female, 65% outpatients, 31% from rural areas, 26% with HF with preserved ejection fraction, with 1294 from Africa, 2661 from Asia, 1000 from the Middle-East, and 858 from South America. Participants from Africa—closely followed by Asians—were younger, had lower literacy levels, and were less likely to have health or medication insurance or be on beta-blockers compared with participants from other regions, but were most likely to be in NYHA class IV. Participants from South America were older, had higher insurance and literacy levels, and, along with Middle Eastern participants, were more likely to be on beta-blockers, but had the lowest proportion in NYHA IV. Ischemic heart disease was the most common HF etiology in all regions except Africa where hypertensive heart disease was most common. Conclusions INTER-CHF describes significant regional variability in socioeconomic and clinical factors, etiologies and treatments in HF patients from Africa, Asia, the Middle East and South America. Opportunities exist for improvement in health/medication insurance rates and proportions of patients on beta blockers, particularly in Africa and Asia.
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    Prognostic value of grip strength : Findings from the Prospective Urban Rural Epidemiology (PURE) study
    (2015-07) Leong, Darryl P.; Teo, Koon; Rangarajan, Sumathy; Lopez-Jaramillo, Patricio; Avezum, Alvaro; Orlandini, Andres; Seron, Pamela; Ahmed, Suad H.; Rosengren, Annika; Kelishadi, Roya; Rahman, Omar; Swaminathan, Sumathi; Iqbal, Romaina; Gupta, Rajeev; Lear, Scott A.; Oguz, Aytekin; Yusoff, Khalid; Zatonska, Katarzyna; Chifamba, Jephat; Igumbor, Ehimario; Mohan, Viswanathan; Anjana, Ranjit Mohan; Gu, Hongqiu; Li, Wei; Yusuf, Salim; The PURE (Prospective Urban Rural Epidemiology) Study investigators
    Background Reduced muscular strength, as measured by grip strength, has been associated with an increased risk of all-cause and cardiovascular mortality. Grip strength is appealing as a simple, quick, and inexpensive means of stratifying an individual's risk of cardiovascular death. However, the prognostic value of grip strength with respect to the number and range of populations and confounders is unknown. The aim of this study was to assess the independent prognostic importance of grip strength measurement in socioculturally and economically diverse countries. Methods The Prospective Urban-Rural Epidemiology (PURE) study is a large, longitudinal population study done in 17 countries of varying incomes and sociocultural settings. We enrolled an unbiased sample of households, which were eligible if at least one household member was aged 35–70 years and if household members intended to stay at that address for another 4 years. Participants were assessed for grip strength, measured using a Jamar dynamometer. During a median follow-up of 4·0 years (IQR 2·9–5·1), we assessed all-cause mortality, cardiovascular mortality, non-cardiovascular mortality, myocardial infarction, stroke, diabetes, cancer, pneumonia, hospital admission for pneumonia or chronic obstructive pulmonary disease (COPD), hospital admission for any respiratory disease (including COPD, asthma, tuberculosis, and pneumonia), injury due to fall, and fracture. Study outcomes were adjudicated using source documents by a local investigator, and a subset were adjudicated centrally. Findings Between January, 2003, and December, 2009, a total of 142 861 participants were enrolled in the PURE study, of whom 139 691 with known vital status were included in the analysis. During a median follow-up of 4·0 years (IQR 2·9–5·1), 3379 (2%) of 139 691 participants died. After adjustment, the association between grip strength and each outcome, with the exceptions of cancer and hospital admission due to respiratory illness, was similar across country-income strata. Grip strength was inversely associated with all-cause mortality (hazard ratio per 5 kg reduction in grip strength 1·16, 95% CI 1·13–1·20; p<0·0001), cardiovascular mortality (1·17, 1·11–1·24; p<0·0001), non-cardiovascular mortality (1·17, 1·12–1·21; p<0·0001), myocardial infarction (1·07, 1·02–1·11; p=0·002), and stroke (1·09, 1·05–1·15; p<0·0001). Grip strength was a stronger predictor of all-cause and cardiovascular mortality than systolic blood pressure. We found no significant association between grip strength and incident diabetes, risk of hospital admission for pneumonia or COPD, injury from fall, or fracture. In high-income countries, the risk of cancer and grip strength were positively associated (0·916, 0·880–0·953; p<0·0001), but this association was not found in middle-income and low-income countries. Interpretation This study suggests that measurement of grip strength is a simple, inexpensive risk-stratifying method for all-cause death, cardiovascular death, and cardiovascular disease. Further research is needed to identify determinants of muscular strength and to test whether improvement in strength reduces mortality and cardiovascular disease. Funding Full funding sources listed at end of paper (see Acknowledgments).
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    Reference ranges of handgrip strength from 125,462 healthy adults in 21 countries : A prospective urban rural epidemiologic (PURE) study
    (2016-03-14) Lopez-Jaramillo, Patricio; Leong, Darryl P.; Teo, Koon; Rangarajan, Sumathy; Raman Kutty, V.; Lanas, Fernando; Hui, Chen; Quanyong, Xiang; Zhenzhen, Qian; Jinhua, Tang; Noorhassim, Ismail; AlHabib, Khalid F.; Moss, Sarah J.; Rosengren, Annika; Arzu Akalin, Ayse; Rahman, Omar; Chifamba, Jephat; Orlandini, Andres; Kumar, Rajesh; Yeates, Karen; Gupta, Rajeev; Yusufali, Afzalhussein; Dans, Antonio; Avezum, Alvaro; Poirier, Paul P.; Heidari, Hosein; Zatonska, Katarzyna; Iqbal, Romaina; Khatib, Rasha; Yusuf, Salim
    Background The measurement of handgrip strength (HGS) has prognostic value with respect to all-cause mortality, cardiovascular mortality and cardiovascular disease, and is an important part of the evaluation of frailty. Published reference ranges for HGS are mostly derived from Caucasian populations in high-income countries. There is a paucity of information on normative HGS values in non-Caucasian populations from low- or middle-income countries. The objective of this study was to develop reference HGS ranges for healthy adults from a broad range of ethnicities and socioeconomically diverse geographic regions. Methods HGS was measured using a Jamar dynamometer in 125,462 healthy adults aged 35-70 years from 21 countries in the Prospective Urban Rural Epidemiology (PURE) study. Results HGS values differed among individuals from different geographic regions. HGS values were highest among those from Europe/North America, lowest among those from South Asia, South East Asia and Africa, and intermediate among those from China, South America, and the Middle East. Reference ranges stratified by geographic region, age, and sex are presented. These ranges varied from a median (25th–75th percentile) 50 kg (43–56 kg) in men <40 years from Europe/North America to 18 kg (14–20 kg) in women >60 years from South East Asia. Reference ranges by ethnicity and body-mass index are also reported. Conclusions Individual HGS measurements should be interpreted using region/ethnic-specific reference ranges.
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    Secondary CV Prevention in South America in a Community Setting : The PURE Study
    (2017-12) Avezum, Alvaro; Oliveira, Gustavo; Lanas, Fernando; Lopez-Jaramillo, Patricio; Diaz, Rafael; Miranda, J. Jaime; Seron, Pamela; Camacho López, Paul Anthony; Orlandini, Andres; Ortiz, Antonio Bernabe; Mattos, Antônio Cordeiro; Islam, Shofiqul; Rangarajan, Sumathy; Teo, Koon; Yusuf, Salim
    Background Despite the availability of evidence-based therapies, there is no information on the use of medications for the secondary prevention of cardiovascular disease in urban and rural community settings in South America. Objectives This study sought to assess the use, and its predictors, of effective secondary prevention therapies in individuals with a history of coronary heart disease (CHD) or stroke. Methods In the PURE (Prospective Urban Rural Epidemiological) study, we enrolled 24,713 individuals from South America ages 35 to 70 years from 97 rural and urban communities in Argentina, Brazil, Chile, and Colombia. We assessed the use of proven therapies with standardized questionnaires. We report estimates of drug use at national, community, and individual levels and the independent predictors of their utilization through a multivariable analysis model. Results Of 24,713 individuals, 910 had a self-reported CHD event (at a median of 5 years earlier) and 407 had stroke (6 years earlier). The proportions of individuals with CHD who received antiplatelet medications (30.1%), beta-blockers (34.2%), angiotensin-converting enzyme inhibitors, or angiotensin-receptor blockers (36.0%), or statins (18.0%) were low; with even lower proportions among stroke patients (antiplatelets 24.3%, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers 37.6%, statins 9.8%). A substantial proportion of patients did not receive any proven therapy (CHD 31%, stroke 54%). A minority of patients received either all 4 (4.1%) or 3 proven therapies (3.3%). Male sex, age >60 years, better education, more wealth, urban location, diabetes, and obesity were associated with higher rates of medication use. In a multivariable model, markers of wealth had the largest impact in secondary prevention. Conclusions There are large gaps in the use of proven medications for secondary prevention of cardiovascular disease in South America. Strategies to improve the sustained use of these medications will likely reduce cardiovascular disease burden substantially.
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    The Anti-Coronavirus Therapies (ACT) Trials: Design, Baseline Characteristics, and Challenges
    (2022-06-05) Eikelboom, John; Rangarajan, Sumathy; Jolly, Sanjit S.; Belley-Cote, Emilie P.; Whitlock, Richard; Beresh, Heather; Lewis, Gayle; Xu, Lizhen; Chan, Noel; Bangdiwala, Shrikant; Diaz, Rafael; Orlandini, Andres; Hassany, Mohamed; Tarhuni, Wadea M.; Yusufali, A.M.; Sharma, Sanjib Kumar; Kontsevaya, Anna; Lopez-Jaramillo, Patricio; Avezum, Alvaro; Dans, Antonio L.; Wasserman, Sean; Felix, Camilo; Kazmi, Khawar; Pais, Prem; Xavier, Denis; Lopes, Renato D.; Berwanger, Otavio; Nkeshimana, Menelas; Harper, William; Loeb, Mark; Choudhri, Shurjeel; Farkouh, Michael E.; Bosch, Jackie; Anand, Sonia S.; Yusuf, Salim; Masira
    Background: Effective treatments for COVID-19 are urgently needed, but conducting randomized trials during the pandemic has been challenging.Methods: The Anti-Coronavirus Therapy (ACT) trials are parallel factorial international trials that aimed to enroll 3500 outpatients and 2500 inpatients with symptomatic COVID-19. The outpatient trial is evaluating colchicine vs usual care, and aspirin vs usual care. The primary outcome for the colchicine randomization is hospitalization or death, and for the aspirin randomization, it is major thrombosis, hospitalization, or death. The inpatient trial is evaluating colchicine vs usual care, and the combination of rivaroxaban 2.5 mg twice daily and aspirin 100 mg once daily vs usual care. The primary outcome for the colchicine randomization is need for high-flow oxygen, need for mechanical ventilation, or death, and for the rivaroxaban plus aspirin randomization, it is major thrombotic events, need for high-flow oxygen, need for mechanical ventilation, or death. Results: At the completion of enrollment on February 10, 2022, the outpatient trial had enrolled 3917 patients, and the inpatient trial had enrolled 2611 patients. Challenges encountered included lack of preliminary data about the interventions under evaluation, uncertainties related to the expected event rates, delays in regulatory and ethics approvals, and in obtaining study interventions, as well as the changing pattern of the COVID-19 pandemic. Conclusions: The ACT trials will determine the efficacy of antiinflammatory therapy with colchicine, and antithrombotic therapy with aspirin given alone or in combination with rivaroxaban, across the spectrum of mild, moderate, and severe COVID-19. Lessons learned from the conduct of these trials will inform planning of future trials.
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    Variations in risks from smoking between high-income, middle-income, and low-income countries. An analysis of data from 179 000 participants from 63 countries
    (The Lancet Global Health, 2022-02-24) Sathish, Thirunavukkarasu; Teo, Koon; Britz-McKibbin, Philip; Gill, Biban; Islam, Shofiqul; Pare, Guillaume; Rangarajan, Sumathy; Duong, MyLinh; Lanas, Fernando; Lopez-Jaramillo, Patricio; Mony, Prem; Pinnaka, Lakshmi; Raman Kutty, Vellappillil; Orlandini, Andres; Avezum, Alvaro; Wielgosz, Andreas; Poirier, Paul; Alhabib, Khalid F.; Temizhan, Ahmet; Chifamba, Jephat; Yeates, Karen; Kruger, Iolanthé M.; Khatib, Rasha; Yusuf, Rita; Rosengren, Annika; Zatonska, Katarzyna; Iqbal, Romaina; Lui, Weida; Lang, Xinyue; Li, Sidong; Hu, Bo; Dans, Antonio; Yusufali, Afzalhussein; Bahonar, Ahmad; O’Donnell, Martin J.; McKee, Martin; Yusuf, Salim; Masira
    Background Separate studies suggest that the risks from smoking might vary between high-income (HICs), middle-income (MICs), and low-income (LICs) countries, but this has not yet been systematically examined within a single study using standardised approaches. We examined the variations in risks from smoking across different country income groups and some of their potential reasons. Methods We analysed data from 134 909 participants from 21 countries followed up for a median of 11·3 years in the Prospective Urban Rural Epidemiology (PURE) cohort study; 9711 participants with myocardial infarction and 11 362 controls from 52 countries in the INTERHEART case-control study; and 11 580 participants with stroke and 11 331 controls from 32 countries in the INTERSTROKE case-control study. In PURE, all-cause mortality, major cardiovascular disease, cancers, respiratory diseases, and their composite were the primary outcomes for this analysis. Biochemical verification of urinary total nicotine equivalent was done in a substudy of 1000 participants in PURE. Findings In PURE, the adjusted hazard ratio (HR) for the composite outcome in current smokers (vs never smokers) was higher in HICs (HR 1·87, 95% CI 1·65–2·12) than in MICs (1·41, 1·34–1·49) and LICs (1·35, 1·25–1·46; interaction p<0·0001). Similar patterns were observed for each component of the composite outcome in PURE, myocardial infarction in INTERHEART, and stroke in INTERSTROKE. The median levels of tar, nicotine, and carbon monoxide displayed on the cigarette packs from PURE HICs were higher than those on the packs from MICs. In PURE, the proportion of never smokers reporting high second-hand smoke exposure (≥1 times/day) was 6·3% in HICs, 23·2% in MICs, and 14·0% in LICs. The adjusted geometric mean total nicotine equivalent was higher among current smokers in HICs (47·2 μM) than in MICs (31·1 μM) and LICs (25·2 μM; ANCOVA p<0·0001). By contrast, it was higher among never smokers in LICs (18·8 μM) and MICs (11·3 μM) than in HICs (5·0 μM; ANCOVA p=0·0001). Interpretation The variations in risks from smoking between country income groups are probably related to the higher exposure of tobacco-derived toxicants among smokers in HICs and higher rates of high second-hand smoke exposure among never smokers in MICs and LICs.
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    Variations in risks from smoking between high-income, middle-income, and low-income countries: an analysis of data from 179 000 participants from 63 countries
    (2022-02-05) Sathish, Thirunavukkarasu; Teo, Koon K.; Britz-McKibbin, Philip; Gill, Biban; Islam, Shofiqul; Paré, Guillaume; Rangarajan, Sumathy; Duong, MyLinh; Lanas, Fernando; Lopez-Jaramillo, Patricio; Mony, Prem K.; Pinnaka, Lakshmi; Kutty, Vellappillil Raman; Orlandini, Andres; Avezum, Alvaro; Wielgosz, Andreas; Poirier, Paul; Alhabib, Khalid F.; Temizhan, Ahmet; Chifamba, Jephat; Yeates, Karen; Kruger, Iolanthé M.; Khatib, Rasha; Yusuf, Rita; Rosengren, Annika; Zatonska, Katarzyna; Iqbal, Romaina; Lui, Weida; Lang, Xinyue; Li, Sidong; Hu, Bo; Dans, Antonio L.; Yusufali, Afzal Hussein; Bahonar, Ahmad; O’Donnell, Martin J.; McKee, Martin; Yusuf, Salim; Masira
    Background Separate studies suggest that the risks from smoking might vary between high-income (HICs), middle-income (MICs), and low-income (LICs) countries, but this has not yet been systematically examined within a single study using standardised approaches. We examined the variations in risks from smoking across different country income groups and some of their potential reasons. Methods We analysed data from 134 909 participants from 21 countries followed up for a median of 11·3 years in the Prospective Urban Rural Epidemiology (PURE) cohort study; 9711 participants with myocardial infarction and 11 362 controls from 52 countries in the INTERHEART case-control study; and 11 580 participants with stroke and 11 331 controls from 32 countries in the INTERSTROKE case-control study. In PURE, all-cause mortality, major cardiovascular disease, cancers, respiratory diseases, and their composite were the primary outcomes for this analysis. Biochemical verification of urinary total nicotine equivalent was done in a substudy of 1000 participants in PURE. Findings In PURE, the adjusted hazard ratio (HR) for the composite outcome in current smokers (vs never smokers) was higher in HICs (HR 1·87, 95% CI 1·65–2·12) than in MICs (1·41, 1·34–1·49) and LICs (1·35, 1·25–1·46; interaction p<0·0001). Similar patterns were observed for each component of the composite outcome in PURE, myocardial infarction in INTERHEART, and stroke in INTERSTROKE. The median levels of tar, nicotine, and carbon monoxide displayed on the cigarette packs from PURE HICs were higher than those on the packs from MICs. In PURE, the proportion of never smokers reporting high second-hand smoke exposure (≥1 times/day) was 6·3% in HICs, 23·2% in MICs, and 14·0% in LICs. The adjusted geometric mean total nicotine equivalent was higher among current smokers in HICs (47·2 μM) than in MICs (31·1 μM) and LICs (25·2 μM; ANCOVA p<0·0001). By contrast, it was higher among never smokers in LICs (18·8 μM) and MICs (11·3 μM) than in HICs (5·0 μM; ANCOVA p=0·0001). Interpretation The variations in risks from smoking between country income groups are probably related to the higher exposure of tobacco-derived toxicants among smokers in HICs and higher rates of high second-hand smoke exposure among never smokers in MICs and LICs.
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    Variations in the financial impact of the COVID-19 pandemic across 5 continents. A cross-sectional, individual level analysis
    (ScienceDirect, 2022-01-28) Khetan, Aditya K.; Yusuf, Salim; Lopez-Jaramillo, Patricio; Szuba, Andrzej; Orlandini, Andres; Mat-Nasir, Nafiza; Oguz, Aytekin; Gupta, Rajeev; Avezum, Alvaro; Rosnah, Ismail; Poirier, Paul; Teo, Koon; Wielgosz, Andreas; Lear, Scott A.; Palileo-Villanueva, Lia M.; Seron, Pamela; Chifamba, Jephat; Rangarajan, Sumathy; Mushtaha, Maha; Mohan, Deepa; Yeates, Karen; McKee, Martin; Mony, Prem; Walli-Attaei, Marjan; Khansaheb, Hamda; Rosengren, Annika; AlHabib, Khalid F.; Kruger, Iolanthe M.; Paucar, María-Jose; Mirrakhimov, Erkin; Assembekov, Batyrbek; Leong, Darryl P.; Masira
    Background COVID-19 has caused profound socio-economic changes worldwide. However, internationally comparative data regarding the financial impact on individuals is sparse. Therefore, we conducted a survey of the financial impact of the pandemic on individuals, using an international cohort that has been well-characterized prior to the pandemic. Methods Between August 2020 and September 2021, we surveyed 24,506 community-dwelling participants from the Prospective Urban-Rural Epidemiology (PURE) study across high (HIC), upper middle (UMIC)-and lower middle (LMIC)-income countries. We collected information regarding the impact of the pandemic on their self-reported personal finances and sources of income. Findings Overall, 32.4% of participants had suffered an adverse financial impact, defined as job loss, inability to meet financial obligations or essential needs, or using savings to meet financial obligations. 8.4% of participants had lost a job (temporarily or permanently); 14.6% of participants were unable to meet financial obligations or essential needs at the time of the survey and 16.3% were using their savings to meet financial obligations. Participants with a post-secondary education were least likely to be adversely impacted (19.6%), compared with 33.4% of those with secondary education and 33.5% of those with pre-secondary education. Similarly, those in the highest wealth tertile were least likely to be financially impacted (26.7%), compared with 32.5% in the middle tertile and 30.4% in the bottom tertile participants. Compared with HICs, financial impact was greater in UMIC [odds ratio of 2.09 (1.88–2.33)] and greatest in LMIC [odds ratio of 16.88 (14.69–19.39)]. HIC participants with the lowest educational attainment suffered less financial impact (15.1% of participants affected) than those with the highest education in UMIC (22.0% of participants affected). Similarly, participants with the lowest education in UMIC experienced less financial impact (28.3%) than those with the highest education in LMIC (45.9%). A similar gradient was seen across country income categories when compared by pre-pandemic wealth status. Interpretation The financial impact of the pandemic differs more between HIC, UMIC, and LMIC than between socio-economic categories within a country income level. The most disadvantaged socio-economic subgroups in HIC had a lower financial impact from the pandemic than the most advantaged subgroup in UMIC, with a similar disparity seen between UMIC and LMIC. Continued high levels of infection will exacerbate financial inequity between countries and hinder progress towards the sustainable development goals, emphasising the importance of effective measures to control COVID-19 and, especially, ensuring high vaccine coverage in all countries.
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    Variations in the financial impact of the COVID-19 pandemic across 5 continents: A cross-sectional, individual level analysis
    (2022-02-05) Khetan, Aditya K.; Yusuf, Salim; Lopez-Jaramillo, Patricio; Szuba, Andrzej; Orlandini, Andres; Mat-Nasir, Nafiza; Oguz, Aytekin; Gupta, Rajeev; Avezum, Álvaro; Rosnah, Ismail; Poirier, Paul; Teo, Koon K.; Wielgosz, Andreas; Lear, Scott A.; Palileo-Villanueva, Lia M.; Serón, Pamela; Chifamba, Jephat; Rangarajan, Sumathy; Mushtaha, Maha; Mohan, Deepa; Yeates, Karen; McKee, Martin; Mony, Prem K.; Walli-Attaei, Marjan; Khansaheb, Hamda; Rosengren, Annika; Alhabib, Khalid F.; Kruger, Iolanthé M.; Paucar, María-José; Mirrakhimov, Erkin; Assembekov, Batyrbek; Leong, Darryl P.; Masira
    Background COVID-19 has caused profound socio-economic changes worldwide. However, internationally comparative data regarding the financial impact on individuals is sparse. Therefore, we conducted a survey of the financial impact of the pandemic on individuals, using an international cohort that has been well-characterized prior to the pandemic. Methods Between August 2020 and September 2021, we surveyed 24,506 community-dwelling participants from the Prospective Urban-Rural Epidemiology (PURE) study across high (HIC), upper middle (UMIC)-and lower middle (LMIC)-income countries. We collected information regarding the impact of the pandemic on their self-reported personal finances and sources of income. Findings Overall, 32.4% of participants had suffered an adverse financial impact, defined as job loss, inability to meet financial obligations or essential needs, or using savings to meet financial obligations. 8.4% of participants had lost a job (temporarily or permanently); 14.6% of participants were unable to meet financial obligations or essential needs at the time of the survey and 16.3% were using their savings to meet financial obligations. Participants with a post-secondary education were least likely to be adversely impacted (19.6%), compared with 33.4% of those with secondary education and 33.5% of those with pre-secondary education. Similarly, those in the highest wealth tertile were least likely to be financially impacted (26.7%), compared with 32.5% in the middle tertile and 30.4% in the bottom tertile participants. Compared with HICs, financial impact was greater in UMIC [odds ratio of 2.09 (1.88 −2.33)] and greatest in LMIC [odds ratio of 16.88 (14.69−19.39)]. HIC participants with the lowest educational attainment suffered less financial impact (15.1% of participants affected) than those with the highest education in UMIC (22.0% of participants affected). Similarly, participants with the lowest education in UMIC experienced less financial impact (28.3%) than those with the highest education in LMIC (45.9%). A similar gradient was seen across country income categories when compared by pre-pandemic wealth status. Interpretation The financial impact of the pandemic differs more between HIC, UMIC, and LMIC than between socio-economic categories within a country income level. The most disadvantaged socio-economic subgroups in HIC had a lower financial impact from the pandemic than the most advantaged subgroup in UMIC, with a similar disparity seen between UMIC and LMIC. Continued high levels of infection will exacerbate financial inequity between countries and hinder progress towards the sustainable development goals, emphasising the importance of effective measures to control COVID-19 and, especially, ensuring high vaccine coverage in all countries. Funding Funding for this study was provided by the Canadian Institutes of Health Research and the International Development Research Centre.