Artículo de revista
Availability and affordability of cardiovascular disease medicines and their effect on use in high-income, middle-income, and low-income countries. An analysis of the PURE study data
Fecha
2016-10-05Autor
Miller, Victoria
Yusuf, Salim
Chow, Clara K.
Dehghan, Mahshid
Corsi, Daniel J.
Lock, Karen
Popkin, Barry
Rangarajan, Sumathy
Khatib, Rasha
Lear, Scott A.
Mony, Prem
Kaur, Manmeet
Mohan, Viswanathan
Vijayakumar, Krishnapillai
Gupta, Rajeev
Kruger, Annamarie
Tsolekile, Lungiswa
Mohammadifard, Noushin
Rahman, Omar
Rosengren, Annika
Avezum, Alvaro
Orlandini, Andrés
Ismail, Noorhassim
Lopez-Jaramillo, Patricio
Yusufali, Afzalhussein
Karsidag, Kubilay
Iqbal, Romaina
Chifamba, Jephat
Oakley, Solange Martinez
Ariffin, Farnaza
Zatonska, Katarzyna
Poirier, Paul
Wei, Li
Jian, Bo
Hui, Chen
Xu, Liu
Xiulin, Bai
Teo, Koon
Mente, Andrew
Institución
Resumen
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 effects 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 high-income 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 affordability. Policies worldwide should enhance the availability and affordability of fruits and vegetables.