Hypertension awareness, treatment, and control and their association with healthcare access in the middle-aged and older Indian population: A nationwide cohort study.
Hypertension awareness, treatment, and control and their association with healthcare access in the middle-aged and older Indian population: A nationwide cohort study.
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DOI：
10.1371/journal.pmed.1003855
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发表时间：
2022-01
期刊：
影响因子：
15.8
通讯作者：
Hu P
中科院分区：
文献类型：
--
作者：
Lee J;Wilkens J;Meijer E;Sekher TV;Bloom DE;Hu P
高血压是印度最重要的心血管危险因素，缺乏对印度中年和老年人的代表性研究。我们的目标是估计已被诊断为高血压的成年人的比例，服用抗高血压药物，并在中年和老年印度人口中实现控制，并调查获得医疗保健和高血压管理之间的关联。我们设计了一项针对印度中老年人群的全国代表性队列研究，即印度纵向老龄化研究（LASI），并分析了2017-2019年基线波（N = 72，262）和2010年试点波（N = 1，683）的数据。高血压定义为自我报告的医生诊断或测量血压（BP）升高，定义为收缩压≥ 140 mm Hg或舒张压≥ 90 mm Hg。在高血压患者中，知晓、治疗和控制分别基于已被诊断、服用降压药物和血压未升高的自我报告来定义。45岁及以上印度人群的高血压估计患病率为45.9%（95% CI 45.4%-46.5%）。在高血压患者中，55.7%（95%CI 54.9%-56.5%）已被诊断，38.9%（95%CI 38.1%-39.6%）服用抗高血压药物，31.7%（95%CI 31.0%-32.4%）血压得到控制。在多变量logistic回归模型中，获得公共医疗保健是高血压治疗的关键预测因素（比值比[OR] = 1.35，95% CI 1.14-1.60，p = 0.001），尤其是在经济上最弱势的群体中（中等经济地位相互作用的OR = 0.76，95%CI 0.61-0.94，p = 0.013;高经济地位相互作用的OR = 0.84，95%CI 0.68-1.05，p = 0.124）。在经济状况较低的人群中，拥有健康保险与高血压意识的提高无关（OR = 0.96，95%CI 0.86-1.07，p = 0.437）和中等经济状况者（交互作用的OR = 1.15，95%CI 1.00-1.33，p = 0.051），但在高经济地位人群中（相互作用的OR = 1.28，95% CI 1.10-1.48，p = 0.001）。比较4个试点州的高血压知晓率、治疗率和控制率，我们发现从2010年到2017-2019年，高血压管理有统计学显著改善（p < 0.001）。这项研究的局限性包括试点样本相对较小，并且仅从4个州招募。尽管不同社会人口群体和地理区域的高血压诊断、治疗和控制存在很大差异，但减少不受控制的高血压仍然是印度公共卫生的首要任务。获得医疗保健与高血压的诊断和治疗密切相关。Jinkook Lee及其同事调查了印度中老年人的高血压管理及其与医疗保健服务的关系。高血压是印度心血管疾病相关死亡率和残疾率上升的最重要驱动因素之一。目前印度中老年人群对高血压管理的了解有限。印度在获得医疗保健方面存在着惊人的差距，获得医疗保健可能与高血压的认识和治疗有关。我们开展了一项具有全国代表性的队列研究，即印度纵向老龄化研究（N = 72，262），并根据诊断和血压测量的自我报告调查了高血压患病率、知晓率、治疗和控制。在45岁及以上的高血压成年人中，55.7%的人被医生告知他们患有高血压，38.9%的人服用抗高血压药物，31.7%的人保持血压控制，并且在各州和社会人口群体中发现高血压护理存在很大差异。获得医疗保健是高血压意识和治疗的关键预测因素，获得公共卫生中心对于经济上最弱势群体的个人获得治疗尤为重要。在印度，高血压的认识、治疗和控制存在着惊人的差异，获得医疗保健与这些差异有关。从2010年到2017-2019年，印度的高血压管理有了很大改善，医疗保险的扩张和公共医疗设施的增长是这一改善的重要贡献者。2010年与2017-2019年之间的比较仅基于4个州的数据，因此其对其他州的推广性有限。
Hypertension is the most important cardiovascular risk factor in India, and representative studies of middle-aged and older Indian adults have been lacking. Our objectives were to estimate the proportions of hypertensive adults who had been diagnosed, took antihypertensive medication, and achieved control in the middle-aged and older Indian population and to investigate the association between access to healthcare and hypertension management. We designed a nationally representative cohort study of the middle-aged and older Indian population, the Longitudinal Aging Study in India (LASI), and analyzed data from the 2017–2019 baseline wave (N = 72,262) and the 2010 pilot wave (N = 1,683). Hypertension was defined as self-reported physician diagnosis or elevated blood pressure (BP) on measurement, defined as systolic BP ≥ 140 mm Hg or diastolic BP ≥ 90 mm Hg. Among hypertensive individuals, awareness, treatment, and control were defined based on self-reports of having been diagnosed, taking antihypertensive medication, and not having elevated BP, respectively. The estimated prevalence of hypertension for the Indian population aged 45 years and older was 45.9% (95% CI 45.4%–46.5%). Among hypertensive individuals, 55.7% (95% CI 54.9%–56.5%) had been diagnosed, 38.9% (95% CI 38.1%–39.6%) took antihypertensive medication, and 31.7% (95% CI 31.0%–32.4%) achieved BP control. In multivariable logistic regression models, access to public healthcare was a key predictor of hypertension treatment (odds ratio [OR] = 1.35, 95% CI 1.14–1.60, p = 0.001), especially in the most economically disadvantaged group (OR of the interaction for middle economic status = 0.76, 95% CI 0.61–0.94, p = 0.013; OR of the interaction for high economic status = 0.84, 95% CI 0.68–1.05, p = 0.124). Having health insurance was not associated with improved hypertension awareness among those with low economic status (OR = 0.96, 95% CI 0.86–1.07, p = 0.437) and those with middle economic status (OR of the interaction = 1.15, 95% CI 1.00–1.33, p = 0.051), but it was among those with high economic status (OR of the interaction = 1.28, 95% CI 1.10–1.48, p = 0.001). Comparing hypertension awareness, treatment, and control rates in the 4 pilot states, we found statistically significant (p < 0.001) improvement in hypertension management from 2010 to 2017–2019. The limitations of this study include the pilot sample being relatively small and that it recruited from only 4 states. Although considerable variations in hypertension diagnosis, treatment, and control exist across different sociodemographic groups and geographic areas, reducing uncontrolled hypertension remains a public health priority in India. Access to healthcare is closely tied to both hypertension diagnosis and treatment. Jinkook Lee and colleagues investigate hypertension management and its association with healthcare access in middle-aged and older adults in India. Hypertension is one of the most important drivers of the rising mortality and disability associated with cardiovascular diseases in India. Current knowledge about hypertension management among middle-aged and older adults in India is limited. Striking disparities in access to healthcare exist in India, and access to healthcare might be tied to hypertension awareness and treatment. We developed a nationally representative cohort study, the Longitudinal Aging Study in India (N = 72,262), and investigated hypertension prevalence, awareness, treatment, and control based on both self-report of diagnosis and blood pressure measurement. Among hypertensive adults aged 45 years and older, 55.7% had been told by a physician that they had hypertension, 38.9% took antihypertensive medication, and 31.7% kept their blood pressure controlled, and large variations in hypertension care were found across states and sociodemographic groups. Access to healthcare was a key predictor of hypertension awareness and treatment, and access to a public health center was especially critical for individuals in the most economically disadvantaged group to get access to treatment. Striking disparities in hypertension awareness, treatment, and control exist in India, and access to healthcare is tied to these disparities. Hypertension management has improved much in India from 2010 to 2017–2019, and health insurance expansion and growth in public healthcare facilities are important contributors to this improvement. Comparisons between 2010 and 2017–2019 were based on data from only 4 states, and therefore their generalizability to other states is limited.
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