Introduction Social capital, characterised by trust, reciprocity and cooperation, is positively associated with a number of health outcomes. We test the hypothesis that among hypertensive individuals, those with greater social capital are more likely to have their hypertension detected, treated and controlled.
Methods Cross-sectional data from 21 countries in the Prospective Urban and Rural Epidemiology study were collected covering 61 229 hypertensive individuals aged 35–70 years, their households and the 656 communities in which they live. Outcomes include whether hypertensive participants have their condition detected, treated and/or controlled. Multivariate statistical models adjusting for community fixed effects were used to assess the associations of three social capital measures: (1) membership of any social organisation, (2) trust in other people and (3) trust in organisations, stratified into high-income and low-income country samples.
Results In low-income countries, membership of any social organisation was associated with a 3% greater likelihood of having one’s hypertension detected and controlled, while greater trust in organisations significantly increased the likelihood of detection by 4%. These associations were not observed among participants in high-income countries.
Conclusion Although the observed associations are modest, some aspects of social capital are associated with better management of hypertension in low-income countries where health systems are often weak. Given that hypertension affects millions in these countries, even modest gains at all points along the treatment pathway could improve management for many, and translate into the prevention of thousands of cardiovascular events each year.
- health economics
- control strategies
- health systems
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Contributors BP, YG, DS, MS, DB and MM wrote the analysis plan and had the primary responsibility of writing this paper. SY conceived and initiated the PURE study, supervised its conduct and data analysis, reviewed and revised all drafts of this manuscript. All other authors coordinated the worldwide study and reviewed and commented on drafts. All authors approved the final draft.
Funding The UK Economic and Social Research Council funded MM, DB and BP for these analyses through a grant (number ES/L014696/1) under its Secondary Data Analysis Initiative scheme. SY is supported by the Mary W Burke endowed chair of the Heart and Stroke Foundation of Ontario. The PURE Study is an investigator-initiated study that is funded by the Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario and through unrestricted grants from several pharmaceutical companies (with major contributions from AstraZeneca (Canada), Sanofi-Aventis (France and Canada), Boehringer Ingelheim (Germany and Canada), Servier and GSK), and additional contributions from Novartis and King Pharma and from various national or local organisations in participating countries. These include: Argentina: Fundacion ECLA; Bangladesh: Independent University, Bangladesh and Mitra and Associates; Brazil: Unilever Health Institute, Brazil; Canada: Public Health Agency of Canada and Champlain Cardiovascular Disease Prevention Network; Chile: Universidad de la Frontera; China: National Center for Cardiovascular Diseases; Colombia: Colciencias, Grant number: 6566-04-18062; India: Indian Council of Medical Research; Malaysia: Ministry of Science, Technology and Innovation of Malaysia Grant Nbr 100 - IRDC/BIOTEK 16/6/21 (13/2007), Grant Number 07-05-IFN-BPH 010, Ministry of Higher Education of Malaysia Grant Nbr 600 - RMI/LRGS/5/3 (2/2011), Universiti Teknologi MARA, Universiti Kebangsaan Malaysia (UKM-Hejim-Komuniti-15-2010); occupied Palestinian territory: the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), occupied Palestinian territory; International Development Research Centre (IDRC), Canada; Philippines: Philippine Council for Health Research & Development (PCHRD); Poland: Polish Ministry of Science and Higher Education Grant Nr 290/W-PURE/2008/0, Wroclaw Medical University; Saudi Arabia: Saudi Heart Association. The Deanship of Scientific Research at King Saud University, Riyadh, Saudi Arabia (Research group number: RG -1436-013); South Africa: The North-West University, SANPAD (SA and The Netherlands Programme for Alternative Development), National Research Foundation, Medical Research Council of SA, The SA Sugar Association (SASA), Faculty of Community and Health Sciences (UWC); Sweden: AFA insurance, grants from the Swedish state under the ALF agreement, Västra Götaland Region (FOUU), the Swedish Heart and Lung Foundation, the Swedish Research Council, the Swedish Council for Health, Working Life and Welfare and the King Gustaf V:s and Queen Victorias Freemasons’Foundation; Turkey: Metabolic Syndrome Society, AstraZeneca, Turkey, Sanofi-Aventis, Turkey; UAE: Sheikh Hamdan Bin Rashid Al Maktoum Award For Medical Sciences and Dubai Health Authority, Dubai UAE.
Disclaimer The opinions expressed and arguments employed herein are solely those of the authors and do not necessarily reflect the official views of the OECD or of its member countries.
Competing interests None declared.
Ethics approval Ethics committees in each of the 21 participating countries approved the protocol.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data for this study and related studies from the PURE and EPOCH studies are stored at the Population Health Research Institute (PHRI), McMaster University. Requests for PURE and EPOCH data are assessed by the study steering committee and applications can be made to the study project manager, Sumathy Rangarajan (firstname.lastname@example.org).
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