Individual-level Characteristics Research Articles

Attitudes towards homosexuality among ethnic majority and minority adolescents in Western Europe: The role of ethnic classroom composition

Ethnic minorities from more traditional countries tend to hold more conservative views towards homosexuality compared to the ethnic majority population in Western Europe. Assimilation theory predicts that this difference diminishes over time because of exposure and contact between these groups. The role of ethnic classroom composition in this process of cultural assimilation is poorly understood. Therefore, this article examines the role of the country of origin of adolescents and their classroom peers in the assimilation of attitudes towards homosexuality. Using two-wave panel data on 18,058 students in 867 classrooms in England, Germany, the Netherlands, and Sweden, we find that the attitudes towards homosexuality in classroom peers’ country of origin are positively associated with attitudes towards homosexuality of respondents in the first wave but have no effect on subsequent changes in these attitudes over a two-year period. We find some variations in this association according to individual-level characteristics, but these results are not consistent across the countries that we study. Together, these results suggest that the classroom is an important socializing context in the formation of cultural values, and that its influence is relatively uniform across groups.

Flooding and emergency department visits: Effect modification by the CDC/ATSDR Social Vulnerability Index

The Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR) Social Vulnerability Index (SVI) is a census-based metric that includes 15 socioeconomic and demographic factors split into four themes relevant to disaster planning, response, and recovery. Using CDC/ATSDR SVI, health outcomes, and remote sensing data, we sought to understand the differences in the occurrence of overall and cause-specific emergency department (ED) visits before and after a 2017 flood event in Texas following Hurricane Harvey, modified by different levels of social vulnerability. We used a controlled before-after study design to estimate the association between flooding and overall and cause-specific ED visits after adjusting for the baseline period, seasonal trends, and individual-level characteristics. We estimated rate ratios stratified by CDC/ATSDR SVI quartiles (overall and 4 themes separately) and tested for the presence of effect modification. Positive effect modification was found such that total ED visits from flooded census tracts with moderate, high, and very high levels of social vulnerability were less reduced compared to tracts with the least vulnerability during flooding and the month following the flood event. The CDC/ATSDR SVI socioeconomic status theme, household composition and disability theme, and housing and transportation type theme explained this result. We found predominantly negative effect modification with higher ED visits among tracts with the least vulnerability for ED visits related to insect bites, dehydration, and intestinal infectious diseases.

Adolescent individual, school, and neighborhood influences on young adult hypertension risk.

Geographic and contextual socioeconomic risk factors in adolescence may be more strongly associated with young adult hypertension than individual-level risk factors. This study examines the association between individual, neighborhood, and school-level influences during adolescence on young adult blood pressure. Data were analyzed from the National Longitudinal Study of Adolescent to Adult Health (1994-1995 aged 11-18 and 2007-2008 aged 24-32). We categorized hypertension as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg. Secondary outcomes included continuous systolic and diastolic blood pressure. We fit a series of cross-classified multilevel models to estimate the associations between young adulthood hypertension with individual-level, school-level, and neighborhood-level factors during adolescence (i.e., fixed effects) and variance attributable to each level (i.e., random effects). Models were fit using Bayesian estimation procedures. For linear models, intra-class correlations (ICC) are reported for random effects. The final sample included 13,911 participants in 128 schools and 1,917 neighborhoods. Approximately 51% (7,111) young adults were hypertensive. Individual-level characteristics-particularly older ages, Non-Hispanic Black race, Asian race, male sex, BMI, and current smoking-were associated with increased hypertension. Non-Hispanic Black (OR = 1.21; 95% CI: 1.03-1.42) and Asian (OR = 1.28; 95% CI: 1.02-1.62) students had higher odds of hypertension compared to non-Hispanic White students. At the school level, hypertension was associated with the percentage of non-Hispanic White students (OR for 10% higher = 1.06; 95% CI: 1.01-1.09). Adjusting for individual, school, and neighborhood predictors attenuated the ICC for both the school (from 1.4 null to 0.9 fully-adjusted) and neighborhood (from 0.4 to 0.3). We find that adolescents' schools and individual-level factors influence young adult hypertension, more than neighborhoods. Unequal conditions in school environments for adolescents may increase the risk of hypertension later in life. Our findings merit further research to better understand the mechanisms through which adolescents' school environments contribute to adult hypertension and disparities in hypertension outcomes later in life.

Comparative analysis of contraceptive use in Punjab and Manipur: exploring beyond women\u2019s education and empowerment

BackgroundWomen’s education and empowerment are important predictors of contraceptive use across countries. However, two of the Indian states, namely, Punjab and Manipur, showed large variations in contraceptive use, despite the similar level of women’s educational attainment and empowerment. Therefore, this paper attempts to understand variation in contraceptive use between these states, despite having similar level of educational attainment and empowerment among the married women.MethodsThis study primarily used cross-sectional data of the National Family Health Survey (NFHS) 2015–16 and to some extent the District Level Household Survey (DLHS) 2012–13 data. The analytical sample includes 13,730 currently married women in Punjab and 8,872 in Manipur. Modern contraceptive prevalence rate (mCPR) is the key outcome variable of this study. Bivariate, multivariate, and multilevel regression analysis are applied to understand the differences in mCPR between these states and its determinants.ResultsMean years of schooling was about 8 years among women of both the states, and about 34% of the women in Punjab and 27% of the women in Manipur have high level of autonomy. Despite this, use of modern method was 66% in Punjab and only 13% in Manipur. Coverage of family planning program indicators were significantly lower in Manipur than Punjab – frontline workers’ (FLWs) outreach for family planning was only 18% in Manipur compared to 52% in Punjab. Similarly, only 11% of the public health facilities in Manipur compared to 50% of the health facilities in Punjab were ready to provide at least one clinical method of family planning.ConclusionDespite the similar level of individual level characteristics across the two states, poor coverage of family planning programs – low outreach of FLWs, low level of facility readiness, as well as sociocultural norms discouraging contraceptive use – might be responsible for lower contraceptive use in Manipur than Punjab. This implies for strengthening the health system for family planning in Manipur to meet the contraception needs of women by addressing sociocultural barriers in the state.

Patient-, Hospital-, and System-Level Factors Associated With 30-Day Readmission After a Psychiatric Hospitalization

Readmission after inpatient care for a psychiatric condition is associated with a range of adverse events including suicide and all-cause mortality. This study estimated 30-day readmission rates in a large cohort of inpatient psychiatric admissions in New York State and examined how these rates varied by patient, hospital, and service system characteristics. Data were obtained from Medicaid claims records, and clinician, hospital, and region data, for individuals with a diagnosis of any mental disorder admitted to psychiatric inpatient units in New York State from 2012 to 2013. Psychiatric readmission was defined as any unplanned inpatient stay with a mental health diagnosis with an admission date within 30 days of being discharged. Unadjusted and adjusted odds ratios of being readmitted within 30 days were estimated using logistic regression analyses. Over 15% of individuals discharged from inpatient units between 2012 and 2013 were readmitted within 30 days. Patients who were readmitted were more likely to be homeless, have a schizoaffective disorder or schizophrenia, and have medical comorbidity. Readmission rates varied in this cohort mainly because of individual-level characteristics. Homeless patients were at the highest risk of being readmitted after discharge.

Multi-level predictors of sexual autonomy among married women in Nigeria

BackgroundExtant studies have established diverse individual-level and relational-level predictors of sexual autonomy among women in different countries. However, information remains scanty about the predictors beyond the individual and relational levels particularly at the community level. This study examined the multi-level predictors of sexual autonomy in Nigeria. This was done to shed more light on the progression toward attaining women-controlled safe sex in Nigeria.MethodsThis study adopted a cross-sectional design that utilised the 2018 Nigeria Demographic and Health Survey (NDHS) data. The study analysed responses from 8,558 women. The outcome variable was sexual autonomy, while the explanatory variables were individual-level (maternal age group, maternal education, nature of first marriage, parity, work status, religion, and media exposure), relational-level (spousal violence, type of marriage, spousal living arrangement, household wealth quintile, alcoholic consumption, family decision-making, and degree of marital control), and community-level characteristics (community residency type, geographic region, community literacy, female financial inclusion in community, female ownership of assets in community, and community rejection of wife-beating). Statistical analyses were performed using Stata version 14. The multilevel regression analysis was applied. Statistical significance was set at p < 0.05.ResultsFindings showed that parity, nature of first marriage, maternal education, media exposure, work status, and religion were significant individual-level predictors, while spousal violence, degree of marital control, type of marriage, family decision-making, and household wealth quintile were significant relational-level predictors of sexual autonomy. Results further showed that community-level characteristics also significantly predicted sexual autonomy. The likelihood of sexual autonomy was lower among rural women (aOR = 0.433; 95% CI 0.358–0.524), while the odds of sexual autonomy were higher among Southern women (aOR = 3.169; 95% CI 2.594–3.871), women who live in high literate communities (aOR = 3.446; 95% CI 3.047–3.897), women who reside in communities with high female financial inclusion (aOR = 3.821; 95% CI 3.002–4.864), and among women who live in communities with high female ownership of assets (aOR = 1.907; 95% CI 1.562–2.327).ConclusionWomen’s sexual autonomy was predicted by factors operating beyond the individual and relational levels. Existing sexual health promotion strategies targeting individual and relational factors in the country should be modified to adequately incorporate community-level characteristics. This will enhance the prospect of women-controlled safe sex in Nigeria.

Racial and ethnic disparities in access to and enrollment in high-quality Medicare Advantage plans.

Racial and ethnic minority enrollees in Medicare Advantage (MA) plans tend to be in lower-quality plans, measured by a 5-star quality rating system. We examine whether differential access to high-rated plans was associated with this differential enrollment in high-rated plans by race and ethnicity among MA enrollees. The Medicare Master Beneficiary Summary File and MA Landscape File for 2016. We first examined county-level MA plan offerings by race and ethnicity. We then examined the association of racial and ethnic differences in enrollment by star rating by controlling for the following different sets of covariates: (1) individual-level characteristics only, and (2) individual-level characteristics and county-level MA plan offerings. Not applicable PRINCIPAL FINDINGS: Racial and ethnic minority enrollees had, on average, more MA plans available in their counties of residence compared to White enrollees (16.1, 20.8, 20.2, vs. 15.1 for Black, Asian/Pacific Islander, Hispanic, and White enrollees), but had fewer number of high-rated plans (4-star plans or higher) and/or more number of low-rated plans (3.5-star plans or lower). While racial and ethnic minority enrollees had lower enrollment in 4-4.5 star plans than White enrollees, this difference substantially decreased after accounting for county-level MA plan offerings (-9.1 to -0.5 percentage points for Black enrollees, -15.9 to -5.0 percentage points for Asian/Pacific Islander enrollees, and -12.7 to 0.6 percentage points for Hispanic enrollees). Results for Black enrollees were notable as the racial difference reversed when we limited the analysis to those who live in counties that offer a 5-star plan. After accounting for county-level MA plan offerings, Black enrollees had 3.2 percentage points higher enrollment in 5-star plans than White enrollees. Differences in enrollment in high-rated MA plans by race and ethnicity may be explained by limited access and not by individual characteristics or enrollment decisions.

Role of neighbourhood social characteristics in children’s use of mental health services between ages 9 and 13 years: a population-based cohort study in the Netherlands

ObjectivesThis study aims to investigate the association of neighbourhood socioeconomic status (SES) and social cohesion (SC) within the neighbourhood with mental health service use in children, independent of individual-level characteristics...

Insurance coverage and health care spending by state-level Medigap regulations.

Medigap protects traditional Medicare (TM) beneficiaries against catastrophic expenses. Federal regulations around Medigap enrollment and pricing are limited to the first 6 months after turning 65 years old. Eight states institute regulations that apply to later enrollment; half use community rating (charging everyone the same premium) and half use both community rating and guaranteed issue (requiring insurers to accept any beneficiary irrespective of health conditions). We examined the impact of state-level Medigap regulations on insurance coverage and health care spending for Medicare beneficiaries. We used a retrospective cohort study design. Using the 2010-2016 Medicare Current Beneficiary Survey, we identified beneficiaries with TM only, TM + Medigap, or Medicare Advantage (MA) by state-level Medigap regulations. Outcomes were insurance coverage and health care spending. We used an instrumental variable approach to address endogenous insurance choice. We conducted 2-stage least squares regression while controlling for individual-level characteristics and area-level demographic characteristics. Then we used the recycled prediction methods to predict enrollment and spending outcomes for the 3 state-level Medigap regulation scenarios. Although enrollment in TM only was consistent across regulation scenarios, the scenario with community rating and guaranteed issue had lower Medigap enrollment and higher MA enrollment than the no-regulation scenario. Despite negligible health differences, TM + Medigap beneficiaries had higher Medicare spending than TM-only beneficiaries, suggesting moral hazard. Our findings suggest a link between additional regulations and lower Medigap and higher MA enrollment. Policy makers should consider the potential effects on insurance coverage, premiums, financial protection, and moral hazard when designing Medigap regulations.

Social-ecological factors related to preventive behaviors during the COVID-19 pandemic in South Korea.

Most studies on COVID-19 preventive behaviors have focused on single-level factors such as national policy, community social capital, or individuals’ sociodemographic characteristics. Through a social-ecological model, this study attempts to comprehensively examine the multilevel factors associated with COVID-19 preventive practices in South Korea. Accordingly, a web survey involving 1,500 participants was conducted in December 2020. An ordinary least squares (OLS) regression was used to examine the multilevel factors (individual, interpersonal, community, and policy levels) related to COVID-19 preventive measures, which are based on wearing a mask, washing hands, covering the mouth when coughing or sneezing, and social distancing. When factors at each level were investigated, higher scores of COVID-19 fear and correct knowledge at the individual level, COVID-19 information share at the interpersonal level, and better evaluation of the national government policies in regard to COVID-19 at the policy level were positively associated with COVID-19 preventive behaviors. Community-level factors—neighborhood perception and community participation—were negatively significantly related to COVID-19 preventive behaviors. Additionally, older age, being female, and having a graduate-level education were positively related to better preventive behaviors. The findings of the current study suggest that multilevel efforts are needed to promote preventive behaviors. Specifically, more effort to alleviate COVID-19-related fear and disseminate correct knowledge among Korean citizens is needed as the individual-level characteristics explained the preventive behaviors more than the factors at upper levels.

The role of health facility and individual level characteristics on medication adherence among PLHIV on second-line antiretroviral therapy in Northeast Ethiopia: use of multi-level model

BackgroundMedication adherence plays a pivotal role in achieving the desired treatment outcomes. The proportion of HIV patients on second-line antiretroviral therapy is becoming a growing public health concern. However, to date, little attention has been given to second-line antiretroviral medication adherence. Moreover, the association between health facility characteristics and medication adherence has yet not been tested. Thus, this research was conducted to determine the magnitude of medication adherence and examine the role of facility-level determinants among HIV patients on second-line ART.MethodsA cross-sectional study was conducted on 714 HIV patients on second-line therapy who were selected via systematic random sampling in twenty public health facilities. Medication adherence was measured using the six-item Simplified Medication Adherence Questionnaire (SMAQ) tool. Data were collected in a personal interview as well as document reviews. A multi-level binary logistic regression was used to uncover individual and facility-level determinants. The effect size was presented using an adjusted odds ratio (AOR), and statistical significance was declared at a P value less than 0.05.ResultsThe magnitude of optimal medication adherence among HIV patients on second-line antiretroviral therapy was 69.5% (65.9–72.7%). Medication adherence was positively associated with the use of adherence reminder methods [AOR = 3.37, (95% CI 2.03–5.62)], having social support [AOR = 1.11, (95% CI 1.02–1.23)], and not having clinical depression [AOR = 3.19, (95% CI 1.93–5.27). The number of adherence counselors [AOR = 1.20, (95% CI 1.04–1.40)], teamwork for enhanced adherence support [AOR = 1.82, (95% CI 1.01–3.42)], and caseloads at ART clinics were all significantly correlated with ARV medication adherence at the facility level.ConclusionsA large proportion of HIV patients on second-line antiretroviral therapy had adherence problems. Both facility-level and individual-level were linked with patient medication adherence. Thus, based on the identified factors, individual and system-level interventions should be targeted.

The Relationship Between Formal Help-Seeking and Sexual Orientation Among Victims of Domestic Violence.

Domestic violence, broadly defined, includes violence among children, parents, siblings, intimate partners, and other relatives. Help-seeking behaviors for domestic violence, especially among sexual minority (gay, lesbian, bisexual, and others who are not heterosexual) victims, is not well understood. Using the National Crime Victimization Survey, the current study fills a gap in the literature regarding the relationship between sexual orientation and four types of formal help-seeking among victims of violence perpetrated by a relative or an intimate partner: reporting to the police, seeking psychological care, contacting a victim services agency, and seeking medical assistance. This study additionally examined whether individual and incident level variables are related to formal domestic violence help-seeking among sexual minority victims. Results indicate that sexual orientation was significantly related to seeking psychological care and help from a victim services agency, and the relationship between individual and incident level characteristics varies by type of help-seeking among victims of domestic violence. These results suggest that sexual minority victims' decisions to access services is likely influenced by the availability of services and victims' perceptions of how they would be treated within the various systems. Future research should continue to examine the help-seeking process among sexual minority victims of domestic violence in order to develop appropriate policy responses and provide services needed by this population.

Compliance With Epidemic Prevention Guidelines Among Wuhan Citizens Under the Stressors of the COVID-19 Pandemic: A Cross-Sectional Multidistrict Comparative Analysis.

The current study aims to compare compliance with the COVID-19 prevention guidelines among citizens from 13 districts in Wuhan and to explore the influence of individual-level psychological factors and district-level factors on compliance. A total of 811 participants (52% females) from 13 districts in Wuhan were invited to complete surveys regarding demographics, psychosocial factors and compliance with epidemic prevention guidelines. Individual-level characteristics were combined with district-level measures to create multilevel predictive models of compliance with prevention guidelines, and used the Hierarchical Linear Model (HLM) to analyze the data. Findings revealed that there were significant differences in the compliance of citizens from 13 districts of Wuhan (F = 5.65, P < 0.001). Hierarchical linear model analysis revealed that the risk factors case growth rate, COVID-19-related perceived stress, anxiety, significantly negatively predicted compliance. Hope and conscientiousness significantly positively predicted compliance with prevention guidelines, and the negative predictive effect of anxiety disappeared. Overall, we found significant differences in compliance with prevention guidelines among different districts. Risk factors at the individual level have had a negative impact on individuals’ compliance with prevention guidelines, but this impact can be mitigated by the positive role of personal protective factors such as conscientiousness and hope.

Personality, gender, and age resilience to the mental health effects of COVID-19

RationaleUnderstanding the impact of COVID-19 on different population cohorts and which personality traits affected individual's coping responses can help identify strategies to promote self-directed behaviours, thereby enhancing and maintaining individual's mental well-being. ObjectiveUsing longitudinal data for the UK, we examine the impact of the COVID-19 pandemic on individuals’ mental well-being, focusing on age, gender, and personality traits as possible modifiers. MethodsWe explore the longitudinal nature of the data using individual fixed effects models, which implicitly control for unobserved time-invariant individual-level characteristics. Our sample is an unbalanced panel consisting of 373,555 person-years observations, observed from 2009 until June 2020. ResultsThe negative impacts of the first months of the pandemic period are found to be larger for young adults (aged 16–25 years) and vary by personality traits. The increase in psychological distress symptoms is more pronounced for individuals who score higher in neuroticism, extroversion, and openness to experience. Indeed, for introverted young people, recent events may have actually brought a sense of calm. Other findings indicate that worsening in the psychological distress level occurs alongside with increased feelings of loneliness. ConclusionsOur findings support the theoretical knowledge that different people have different psychological and behaviour responses and personality concepts can be used when studying individual's adaptive behaviour in critical situations such as COVID-19. Our results indicate the necessity of public health programmes to assist distressed young individuals.

Do structural choice theory and the ‘risky lifestyles’ perspectives predict immunity as well as victimization? A test using zero-inflated mixed-effect SEM analyses of adolescent victimizations in South Korea

Adolescent victimization experiences can cause serious distress to victims and have been shown to be international phenomena. While victimization in various forms tends to peak in adolescence, its trajectories vary depending on individual and structural characteristics as well as the type of offending. Using structural choice theory and the ‘risky lifestyles’ perspective as our framework, the present study expanded on prior research by examining adolescent victimization in South Korea and using sophisticated statistical models to examine the unique predictors of ‘immunity’ in addition to victimization. In doing so, we supported previous research indicating that structural choice theory predicts adolescent victimization, but we added to that literature in finding that immunity was also a function of one’s environment as well as individual-level characteristics.

Static home-based versus dynamic mobility-based assessments of exposure to urban green space

There is growing interest in urban green space exposure estimated dynamically by accounting for individuals’ mobility during daily life. We aimed to explore if daily green space exposure estimates based on individuals’ mobility substantially differ from static home-based exposure estimates, and to examine potential effect modification by personal (sex and work status) and temporal (weekends versus weekdays) characteristics. To assess the association between daily exposure to urban green space, we used home address and time-activity data collected from 1911 participants in western New York, US, using their GPS-enabled mobile phones. We abstracted both individuals’ home address based (home-based) and daily time activity based (mobility-based) green space exposures from the Normalized Difference Vegetation Index (NDVI). Then, we assessed the association between mobility-based and home-based exposure estimates using linear mixed effect regression models with subject-specific random effects. We also explored whether this effect was modified by individual-level characteristics, including work status and sex, as well as whether assessments took place on weekdays versus weekends. We found that daily dynamic exposure to urban green space based on individuals’ mobility was not substantially different from static exposure estimates based on one’s residence, but that there were statistically significant effect modifiers. Specifically, the correspondence between mobility-based and home-based exposure to green space was relatively lower for employed compared to unemployed participants, whereas their correspondence during weekends increased compared to weekdays. Our findings suggest that there is a strong correspondence between mobility-based and home-based exposure to urban green space, but that their associations are modified by personal and temporal characteristics. Further research is needed to confirm our finding for general population in other settings, such as different seasons and other regions.

Novice early childhood teachers’ perceptions of their professional development experiences: an interpretive phenomenological approach

ABSTRACT Professional development is an important tool for supporting early childhood teachers in implementing developmentally appropriate practices and child-guided instruction in the classroom. This phenomenological study explored five U.S. novice early childhood education teachers’ experiences with professional development. Specifically, we explored how these teachers’ perceptions of their professional development experiences were interwoven with individual-level characteristics and organizational-level features. Findings suggest that participating teachers’ self-efficacy and perceptions of school climate strongly influenced their perceptions of professional development. Participants described valuing hands-on learning opportunities and social support. All reported feeling unprepared for certain aspects of their role as an early educator; however, participants responded to these feelings differently. Findings have implications for improving induction and professional development for novice early childhood educators.

Ordinal health disparities between population subgroups: measurement and multivariate analysis with an application to the North-South divide in England

Health disparities between population subgroups classified on the basis of nominal characteristics such as sex, caste, race or region are of major academic and policy concern. The paper develops a novel analytical framework to not only measure differences in ordinal health outcomes between population subgroups but also account for such disparities in terms of the individual-level socioeconomic and demographic characteristics of their members. The measurement approach is directly applicable to the ordinal health and well-being data commonly available from general social surveys, building on the concept of statistical preference to motivate the definition of summary indices of comparative subgroup health and between-group variation in health. The analysis employs indirect standardisation techniques based on the estimation of a health distribution regression model for the population to identify the effects of compositional and conditional health differences on subgroup health outcomes. An illustrative empirical study finds that about half of the regional variation in self-reported health within England in 2016/17 can be accounted for by sociodemographic factors, with age and educational qualifications both more important predictors than income.

Variation in Patient-Described Barriers to and Facilitators of Diabetes Management by Individual-Level Characteristics: A Cross-Sectional, Open-Ended Survey.

This study analyzed patient-described barriers and facilitators related to diabetes management, focusing on how these differ by glycemia and across individual characteristics. A cross-sectional telephone survey was conducted with adult patients with diabetes in Alberta, Canada, asking two open-ended questions to describe the most helpful and difficult components of their diabetes management. Responses were analyzed using directed content analysis using the Theoretical Domains Framework as a template. The most frequently cited facilitator was care context and information, and the most frequently cited barriers were cognitive challenges and structural barriers, with patient-perceived barriers and facilitators varying by individual-level factors.

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

SummaryBackgroundIn 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.MethodsWe 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.FindingsThe 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]).InterpretationIn 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.FundingNational Clinician Scholars Program at the University of Michigan Institute for Healthcare Policy and Innovation, and National Institute of Diabetes and Digestive and Kidney Diseases.