The state of hypertension care in 44 low-income and middle-income countries: a cross-sectional study of nationally representative individual-level data from 1.1 million adults
The state of hypertension care in 44 low-income and middle-income countries: a cross-sectional study of nationally representative individual-level data from 1.1 million adults
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DOI：
10.1016/s0140-6736(19)30955-9
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发表时间：
2019-08-24
期刊：
影响因子：
168.9
通讯作者：
Jaacks, Lindsay M.
中科院分区：
文献类型：
--
作者：
Geldsetzer, Pascal;Manne-Goehler, Jennifer;Jaacks, Lindsay M.
在低收入和中等收入国家（LMICs）进行的全国代表性研究中，关于高血压患者在护理连续性中的损失的证据很少。然而，这些信息对于卫生服务部门有效地确定干预措施的目标和监测改善高血压护理的进展至关重要。我们的目的是确定级联的高血压护理在44个低收入国家之间的国家和人口组的变化，通过划分在护理过程中的进展，从需要的护理成功的治疗，到离散的阶段和测量的损失在每个stages.Methods在这个横断面研究中，我们汇集了个人层面的人口为基础的数据从44个低收入国家。我们首先从2005年或以后的WHO逐步监测方法（STEPS）中检索了具有全国代表性的数据集。如果STEPS数据集不适用于LMIC（或者我们无法访问它），我们对调查数据集进行了系统搜索;这些检索中的纳入标准是调查在2005年或之后完成，对于至少三个大于15岁的10岁年龄组具有全国代表性，包括测量的血压数据，并且包含关于至少两个高血压护理级联步骤的数据。高血压定义为收缩压至少140 mm Hg，舒张压至少90 mm Hg，或报告使用高血压药物。在高血压患者中，我们计算了曾经测量过血压的人的比例;已经被诊断患有高血压;已经接受高血压治疗;并且已经控制了他们的高血压。在确定全球和区域层面的高血压护理级联时，我们根据各国的人口规模按比例对各国进行加权。我们按年龄、性别、教育、家庭财富五分位数、体重指数、吸烟状况、国家和地区对高血压护理级联进行了分类。我们使用线性回归预测，分别为每个级联步骤，一个国家的表现的基础上，人均国内生产总值（GDP），使我们能够确定国家的表现落在95%的预测interval.Findings我们的汇总数据集包括1 100 507名参与者，其中192 441（17.5%）有高血压。在高血压患者中，（95%CI 72.9-74.3）曾测量过血压，39.2%的参与者（38.2-40.3）人曾被诊断为高血压，29.9%的参与者（28.6-31.3）接受了治疗，10.3%的参与者（9.6-11.0）实现了高血压控制。相对于按人均国内总产值计算的预测业绩，拉丁美洲和加勒比国家的业绩普遍最好，而撒哈拉以南非洲国家的业绩最差。孟加拉国、巴西、哥斯达黎加、厄瓜多尔、吉尔吉斯斯坦和秘鲁在所有护理级联步骤上的表现明显好于根据人均国内生产总值预测的情况。作为一个女人，老年人，更受教育，更富有，而不是一个当前的吸烟者都与实现每一个护理cascades.Interpretation的四个步骤我们的研究提供了重要的证据，在低收入国家的高血压的健康政策和服务干预的设计和针对性。我们展示了在我们研究的44个国家中，每个国家的高血压护理过程中存在哪些步骤和针对哪些人的差距。我们还确定了世界各地区经济发展表现好于预期的国家，这可以指导政策制定者汲取重要的政策教训。鉴于低收入国家高血压造成的高疾病负担，本研究中构建的具有全国代表性的高血压护理级联是实现全民健康覆盖进展的重要衡量标准。版权所有（C）2019 Elsevier Ltd.保留所有权利。
Background Evidence from nationally representative studies in low-income and middle-income countries (LMICs) on where in the hypertension care continuum patients are lost to care is sparse. This information, however, is essential for effective targeting of interventions by health services and monitoring progress in improving hypertension care. We aimed to determine the cascade of hypertension care in 44 LMICs- and its variation between countries and population groups-by dividing the progression in the care process, from need of care to successful treatment, into discrete stages and measuring the losses at each stage.Methods In this cross-sectional study, we pooled individual-level population-based data from 44 LMICs. We first searched for nationally representative datasets from the WHO Stepwise Approach to Surveillance (STEPS) from 2005 or later. If a STEPS dataset was not available for a LMIC (or we could not gain access to it), we conducted a systematic search for survey datasets; the inclusion criteria in these searches were that the survey was done in 2005 or later, was nationally representative for at least three 10-year age groups older than 15 years, included measured blood pressure data, and contained data on at least two hypertension care cascade steps. Hypertension was defined as a systolic blood pressure of at least 140 mm Hg, diastolic blood pressure of at least 90 mm Hg, or reported use of medication for hypertension. Among those with hypertension, we calculated the proportion of individuals who had ever had their blood pressure measured; had been diagnosed with hypertension; had been treated for hypertension; and had achieved control of their hypertension. We weighted countries proportionally to their population size when determining this hypertension care cascade at the global and regional level. We disaggregated the hypertension care cascade by age, sex, education, household wealth quintile, body-mass index, smoking status, country, and region. We used linear regression to predict, separately for each cascade step, a country's performance based on gross domestic product (GDP) per capita, allowing us to identify countries whose performance fell outside of the 95% prediction interval.Findings Our pooled dataset included 1 100 507 participants, of whom 192 441 (17.5%) had hypertension. Among those with hypertension, 73.6% of participants (95% CI 72.9-74.3) had ever had their blood pressure measured, 39.2% of participants (38.2-40.3) had been diagnosed with hypertension, 29.9% of participants (28.6-31.3) received treatment, and 10.3% of participants (9.6-11.0) achieved control of their hypertension. Countries in Latin America and the Caribbean generally achieved the best performance relative to their predicted performance based on GDP per capita, whereas countries in sub-Saharan Africa performed worst. Bangladesh, Brazil, Costa Rica, Ecuador, Kyrgyzstan, and Peru performed significantly better on all care cascade steps than predicted based on GDP per capita. Being a woman, older, more educated, wealthier, and not being a current smoker were all positively associated with attaining each of the four steps of the care cascade.Interpretation Our study provides important evidence for the design and targeting of health policies and service interventions for hypertension in LMICs. We show at what steps and for whom there are gaps in the hypertension care process in each of the 44 countries in our study. We also identified countries in each world region that perform better than expected from their economic development, which can direct policy makers to important policy lessons. Given the high disease burden caused by hypertension in LMICs, nationally representative hypertension care cascades, as constructed in this study, are an important measure of progress towards achieving universal health coverage. Copyright (C) 2019 Elsevier Ltd. All rights reserved.