Prevalence of angina and co-morbid conditions among older adults in six low- and middle-income countries: Evidence from SAGE Wave 1

Background: Global commitments to reduce cardiovascular disease (CVD) burden by 2025 will require data on CVDs from lower income countries. This study aimed to estimate the prevalence of angina, and its association with hypertension, diabetes, and depression, in six low- and middle-income countries (LMICs). Methods: Data from the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 from China, Ghana, India, Mexico, Russia and South Africa were utilized. Multivariable logistic regression methods were used to examine the factors associated with angina. Results: A total of 31,443 respondents aged 50 years and over were included in these analyses. The prevalence of angina was highest in Russia (39%), lowest in China (8%), and consistently higher in women than men. Angina was comorbid with chronic conditions and depression but patterns varied across countries. Depression was negatively associated with angina among older adults in Ghana but was positively associated with angina in all other countries. Hypertension was associated with increased odds of angina among older adults in China (OR 1.9; 95% CI 1.59–2.25), India (OR 1.4; 95% CI 1.14–1.78) and Russia (OR 3.7; 95% CI 2.33–6.00). Diabetes was associated with higher odds of angina in China (OR 1.6; 95% CI 1.15–2.15), Russia (OR 2.5; 95% CI 1.57–3.87), and South Africa (OR 4.1; 95% CI 2.49–6.88). Conclusions: CVD is a significant contributor to disease burden in LMICs. Angina was often co-morbid with other conditions, therefore compelling health systems to develop longer-term integrated care systems to address co- and multi-morbidity.