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Inequalities and risk factors analysis in prevalence and management of hypertension in India and Nepal: a national and subnational study.

ABSTRACT: BACKGROUND:Hypertension is one of the leading risk factors for cardiovascular diseases in India and Nepal. Socio-economic disparity in these two countries has created wide gap in management of hypertension. However, inequalities in prevalence and management (awareness, treatment, and control) of hypertension is poorly assessed. This study analyzes the risk factors associated with prevalence and management of hypertension in India and Nepal and assesses the wealth-and education-based inequalities in them. METHODS:This study used data from the Demographic and Health Survey; a cross-sectional survey conducted between January 2015 to December 2016 in India and June 2016 to January 2017 in Nepal. A total of 787,713 individuals in India and 14,454 individuals in Nepal aged between 15 and 49?years were included in the study. Respondents were classified as being hypertensive if their systolic blood pressure (SBP) readings were at least 140?mmHg or diastolic blood pressure (DBP) readings were at least 90?mmHg, or if they reported currently taking anti-hypertensive medication. Multilevel logistic regression models with random intercepts at household-and community-levels were used to identify the risk factors associated with prevalence and management of hypertension. For inequality assessment, slope index and relative index of inequalities in prevalence and management of hypertension were estimated. RESULTS:Overall prevalence of hypertension in India and Nepal were 11.4% (95% confidence interval (CI), 11.4-11.5) and 19.6% (95% CI, 18.9-20.2), respectively. Less than one-third of the hypertensive population received treatment and below 20% among them had their blood pressure controlled. In both countries, wealth-and education-based inequalities in awareness, treatment, and control of hypertension were significantly high in urban and rural areas. CONCLUSION:Wealth- and education-based inequalities in prevalence and management of hypertension were high among different socio-economic groups at national and sub-national levels. Tailored strategies are required to effectively manage hypertension in different regions by considering socio-economic and demographic factors.

SUBMITTER: Rauniyar SK

PROVIDER: S-EPMC7469349 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Inequalities and risk factors analysis in prevalence and management of hypertension in India and Nepal: a national and subnational study.

Rauniyar Santosh Kumar SK Rahman Md Mizanur MM Rahman Md Shafiur MS Abe Sarah Krull SK Nomura Shuhei S Shibuya Kenji K

BMC public health 20200903 1

<h4>Background</h4>Hypertension is one of the leading risk factors for cardiovascular diseases in India and Nepal. Socio-economic disparity in these two countries has created wide gap in management of hypertension. However, inequalities in prevalence and management (awareness, treatment, and control) of hypertension is poorly assessed. This study analyzes the risk factors associated with prevalence and management of hypertension in India and Nepal and assesses the wealth-and education-based ineq ...[more]

PMID: 32883278

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Project description:ObjectiveTo examine the prevalence, correlates and sociodemographic inequalities of undiagnosed hypertension in Nepal.DesignThis study used cross-sectional 2016 Nepal Demographic and Health Survey (NDHS) data. Undiagnosed patients with hypertension were defined as an NDHS respondent who was diagnosed as hypertensive (systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg) during the survey, but never took any prescribed anti-hypertensive medicine to lower/control blood pressure and was never identified as having hypertension by a health professional prior the survey. Multiple binary logistic regression analysis was performed, and Concentration Index was measured.SettingNepal.ParticipantsAdult patients with hypertension.ResultsAmong 3334 patients with hypertension, 50.4% remained undiagnosed during the survey in Nepal. Adjusted model reveals that patients who were male, belonged to households other than the highest wealth quintile, and lived in province 4 and province 5 were at higher risk of remaining undiagnosed for hypertension. Patients who were ≥65 years of age and were overweight/obese were at lower risk of remaining undiagnosed for hypertension. The poor-rich gap was 24.6 percentage points (Q1=64.1% vs Q5=39.6%) and poor:rich ratio was 1.6 (Q1/Q5=1.6) in the prevalence of undiagnosed hypertension. Undiagnosed hypertension was disproportionately higher among lower socioeconomic status groups (Concentration Index, C=-0.18). Inequalities in the prevalence of undiagnosed hypertension further varied across other geographic locations, including place of residence, ecological zones and administrative provinces.ConclusionsUndiagnosed hypertension was highly prevalent in Nepal and there were substantial inequalities by sociodemographics and subnational levels. Increasing awareness, strengthening routine screening to diagnose hypertension at primary health service facilities and enactment of social health insurance policy may help Nepal to prevent and control this burden.

Project description:ObjectiveTo analyse published literatures on prevalence, awareness, risk factors and control of hypertension in Nepal.MethodsWe used electronic databases to search relevant articles from January 2000 till October 2020. All relevant data from selected studies were extracted into a standardized form designed in Excel. Statistical analysis was conducted using Comprehensive Meta-Analysis Software (CMA) version 3. Proportions or Odds Ratio (OR) was used to estimate the outcome with 95% confidence interval (CI). The I-squared (I2) test was used for the assessment of heterogeneity.ResultsWe identified a total of 3726 studies after comprehensive database searching. We performed qualitative and quantitative analysis of 40 studies. Pooling data showed 28.52% of patients with hypertension (CI: 26.40-30.75); 45.28% (CI: 38.89-51.83) aware of their high blood pressure; 31.66% (CI: 23.18-41.56) under treatment; 44.4% (CI: 36.17-53.04) had their blood pressure under optimum range. 27.4% (CI: 21.57-34.11) had pre-hypertensive range elevated blood pressure. 25.99% (CI: 21.81-30.65) of females and 34.25% (CI: 30.49-38.21) of male were hypertensive (p = 0.007).The pooling of data showed smokers have 1.43 times (CI: 1.1429-1.7889); and alcohol users have 2.073 times (CI: 1.7154-2.5050) higher risk of having hypertension. Individuals with normal BMI have 53.15% (OR: 0.4685 CI: 0.3543-0.6195); with formal educated have 37.27% (OR: 0.6273, CI: 0.5485-0.7175); and with adequate exercise have 31.6% (OR: 0.6839, CI: 0.5203-0.8991) lower chance of having hypertension.ConclusionOur study shows the prevalence of hypertension in Nepal is high. However, awareness, treatment and subsequently control of high blood pressure are found to be alarmingly low. Hypertension was associated with male gender, smoking, alcohol use, high BMI, no education and inadequate exercise. It calls for more attention to address the burden of hypertension and associated risk factors in Nepal.

Project description:ObjectivesThis is the first attempt to provide estimates on the prevalence of hypertension at the national, state and district level, a prerequisite for designing effective interventions. Besides, the study aims to identify the risk factors of hypertension.DesignWe analysed cross-sectional survey data from the fourth round (2015-2016) of National Family Health Survey (NFHS). NFHS was conducted between January 2015 and December 2016, gathering information on a range of indicators including blood pressure. The age adjusted prevalence of hypertension was calculated for state comparison, while multilevel logistic regression analysis was done to assess the correlates of hypertension.Setting and participantsIndia (2015-2016; n=811 917) aged 15-49.Primary and secondary outcome measuresThe primary outcome is hypertension, which has been defined as systolic blood pressure ?140 mm Hg and/or diastolic blood pressure ?90 mm Hg.ResultsThe age-adjusted prevalence of hypertension in India was 11.3% (95% CI 11.16% to 11.43%) among persons aged between 15 and 49 and was four percentage points higher among males 13.8% (95% CI 13.46% to 14.19%) than among females 10.9% (95% CI 10.79% to 11.06%). Persons in the urban location (12.5%, 95% CI 12.25% to 12.80%) had a marginally higher prevalence than persons in rural location (10.6%, 95% CI 10.50% to 10.78%). The proportion of population suffering from hypertension varied greatly between states, with a prevalence of 8.2% (95% CI 7.58% to 8.85%) in Kerala to 20.3% (95% CI 18.81% to 21.77%) in Sikkim. Advancing age, obesity/overweight, male sex, socioeconomic status and consumption of alcohol were found to be the major predictors of hypertension.ConclusionsHypertension prevalence is now becoming more concentrated among the poor. Policy measures should be taken to improve the hazardous working conditions and growing social pressures of survival responsible for 'life-style' changes such as consumption of high calorie food and alcohol.

Project description:BackgroundRates of diseases and injuries and the effects of their risk factors can have substantial subnational heterogeneity, especially in middle-income countries like Mexico. Subnational analysis of the burden of diseases, injuries, and risk factors can improve characterization of the epidemiological transition and identify policy priorities.Methods and findingsWe estimated deaths and loss of healthy life years (measured in disability-adjusted life years [DALYs]) in 2004 from a comprehensive list of diseases and injuries, and 16 major risk factors, by sex and age for Mexico and its states. Data sources included the vital statistics, national censuses, health examination surveys, and published epidemiological studies. Mortality statistics were adjusted for underreporting, misreporting of age at death, and for misclassification and incomparability of cause-of-death assignment. Nationally, noncommunicable diseases caused 75% of total deaths and 68% of total DALYs, with another 14% of deaths and 18% of DALYs caused by undernutrition and communicable, maternal, and perinatal diseases. The leading causes of death were ischemic heart disease, diabetes mellitus, cerebrovascular disease, liver cirrhosis, and road traffic injuries. High body mass index, high blood glucose, and alcohol use were the leading risk factors for disease burden, causing 5.1%, 5.0%, and 7.3% of total burden of disease, respectively. Mexico City had the lowest mortality rates (4.2 per 1,000) and the Southern region the highest (5.0 per 1,000); under-five mortality in the Southern region was nearly twice that of Mexico City. In the Southern region undernutrition and communicable, maternal, and perinatal diseases caused 23% of DALYs; in Chiapas, they caused 29% of DALYs. At the same time, the absolute rates of noncommunicable disease and injury burdens were highest in the Southern region (105 DALYs per 1,000 population versus 97 nationally for noncommunicable diseases; 22 versus 19 for injuries).ConclusionsMexico is at an advanced stage in the epidemiologic transition, with the majority of the disease and injury burden from noncommunicable diseases. A unique characteristic of the epidemiological transition in Mexico is that overweight and obesity, high blood glucose, and alcohol use are responsible for larger burden of disease than other noncommunicable disease risks such as tobacco smoking. The Southern region is least advanced in the epidemiological transition and suffers from the largest burden of ill health in all disease and injury groups.

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Inequalities and risk factors analysis in prevalence and management of hypertension in India and Nepal: a national and subnational study.

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Inequalities and risk factors analysis in prevalence and management of hypertension in India and Nepal: a national and subnational study.

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