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Hypertension care cascade in Chile: a serial cross-sectional study of national health surveys 2003-2010-2017.

ABSTRACT: BACKGROUND:Trend data on hypertension prevalence and attainment indicators at each step of the care cascade (awareness, treatment, control) are required in Chile. This study aims to quantify trends (2003-2017) in prevalence and in the proportion of individuals with hypertension attaining each step of the care cascade among adults aged 17?years or older, and to assess the impact of lowering the blood pressure (BP) thresholds used to define elevated BP on these indicators. METHODS:We used data from 2003, 2010, and 2017 Chilean national health surveys. Each year we assessed levels of (1) mean systolic (SBP) and diastolic (DBP) blood pressure, (2) hypertension prevalence (BP???140/90?mmHg or use of antihypertensive treatment), and (3) awareness, treatment, and control. Logistic regression on pooled data was used to assess trends in binary outcomes; linear regression was used to assess trends in continuous SBP and DBP. We compared levels of hypertension prevalence using two sources to ascertain antihypertensive treatment (self-reported versus medicine inventory). The 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines were used to re-define hypertension using lower thresholds (BP???130/80?mmHg). RESULTS:Hypertension prevalence was 34.0, 32.0 and 30.8% in 2003, 2010 and 2017, respectively. Levels of treated- and controlled-hypertension were significantly higher in 2017 than in 2003 (65% versus 41% for treatment, P?

SUBMITTER: Passi-Solar A

PROVIDER: S-EPMC7490861 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Hypertension care cascade in Chile: a serial cross-sectional study of national health surveys 2003-2010-2017.

Passi-Solar Álvaro Á Margozzini Paula P Mindell Jennifer S JS Ruiz Milagros M Valencia-Hernandez Carlos A CA Scholes Shaun S

BMC public health 20200914 1

<h4>Background</h4>Trend data on hypertension prevalence and attainment indicators at each step of the care cascade (awareness, treatment, control) are required in Chile. This study aims to quantify trends (2003-2017) in prevalence and in the proportion of individuals with hypertension attaining each step of the care cascade among adults aged 17 years or older, and to assess the impact of lowering the blood pressure (BP) thresholds used to define elevated BP on these indicators.<h4>Methods</h4>W ...[more]

PMID: 32928176

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Project description:OBJECTIVES:This study estimates the prevalence of chronic kidney disease (CKD) among Chilean adults and examines its associations with sociodemographic characteristics, health behaviours and comorbidities. DESIGN:Analysis of cross-sectional data from the two most recent large nationally representative Chilean Health Surveys (Encuesta Nacional de Salud, ENS) 2009-2010 and 2016-2017. PARTICIPANTS:Adults aged 18+ years with serum creatine data (ENS 2009-2010: n=4583; ENS 2016-2017: n=5084). PRIMARY AND SECONDARY OUTCOME MEASURES:Reduced kidney function (CKD stages 3a-5) based on the estimated glomerular filtration rate (eGFR <60?mL/min/1.73 m2) was the primary outcome measure. Using the urine albumin-to-creatinine ratio (ACR ?30?mg/g), increased albuminuria was ascertained among adults aged 40+ years with diabetes and/or hypertension. Both outcomes were analysed using logistic regression with results summarised using OR. CKD prevalence (stages 1-5) among adults aged 40+ years was estimated including participants with an eGFR of >60?mL/min/1.73 m2 but with increased albuminuria (stages 1-2). RESULTS:Overall, 3.2% (95% CI: 2.4% to 3.8%) of adults aged 18+ in?ENS 2016-2017 had reduced kidney function. After full adjustment, participants with hypertension (OR: 2.37; 95%?CI: 1.19 to 4.74) and those with diabetes (OR: 1.66; 95% CI: 1.03 to 2.66) had significantly higher odds of reduced kidney function. In ENS 2016-2017, 15.5% (13.5% to 17.8%) of adults aged 40+ years with diabetes and/or hypertension had increased albuminuria. Being obese versus normal-weight (OR: 1.66; 95% CI: 1.08 to 2.54) and having both diabetes and hypertension versus having diabetes alone (OR: 2.30; 95% CI: 1.34 to 3.95) were significantly associated with higher odds of increased albuminuria in fully-adjusted analyses. At least 15.4% of adults aged 40+ years in ENS 2016-2017 had CKD (stages 1-5), including the 9.6% of adults at CKD stages 1-2. CONCLUSIONS:Prevention strategies and Chilean guidelines should consider the high percentage of adults aged 40 years and older at CKD stages 1-2.

Project description:ObjectivesTo determine whether the prevalence of chronic kidney disease (CKD) in England has changed over time.DesignCross-sectional analysis of nationally representative Health Survey for England (HSE) random samples.SettingEngland 2003 and 2009/2010.Survey participants13,896 adults aged 16+ participating in HSE, adjusted for sampling and non-response, 2009/2010 surveys combined.Main outcome measureChange in prevalence of estimated glomerular filtration rate (eGFR)<60?mL/min/1.73?m2 (as proxy for stage 3-5 CKD), from 2003 to 2009/2010 based on a single serum creatinine measure using an isotope dilution mass spectrometry traceable enzymatic assay in a single laboratory; eGFR derived using Modified Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) eGFR formulae.AnalysisMultivariate logistic regression modelling to adjust time changes for sociodemographic and clinical factors (body mass index, hypertension, diabetes, lipids). A correction factor was applied to the 2003 HSE serum creatinine to account for a storage effect.ResultsNational prevalence of low eGFR (<60) decreased within each age and gender group for both formulae except in men aged 65-74. Prevalence of obesity and diabetes increased in this period, while there was a decrease in hypertension. Adjustment for demographic and clinical factors led to a significant decrease in CKD between the surveyed periods. The fully adjusted OR for eGFR<60?mL/min/1.73?m2 was 0.75 (0.61 to 0.92) comparing 2009/2010 with 2003 using the MDRD equation, and was similar using the CKDEPI equation 0.73 (0.57 to 0.93).ConclusionsThe prevalence of a low eGFR indicative of CKD in England appeared to decrease over this 7-year period, despite the rising prevalence of obesity and diabetes, two key causes of CKD. Hypertension prevalence declined and blood pressure control improved but this did not appear to explain the fall. Periodic assessment of eGFR and albuminuria in future HSEs is needed to evaluate trends in CKD.

Project description:OBJECTIVES:We report hospitalisation trends for different age groups across the states of India and for various disease groups, compare the hospitalisation trends among the older (aged 60 years or more) and the younger (aged under 60 years) population and quantify the factors that contribute to the change in hospitalisation rates of the older population over two decades. DESIGN:Serial cross-sectional study. SETTING:Nationally representative sample, India. DATA SOURCES:Three consecutive National Sample Surveys (NSS) on healthcare utilisation in 1995-1996, 2004 and 2014. PARTICIPANTS:Six hundred and thirty-three thousand four hundred and five individuals in NSS 1995-1996, 385?055 in NSS 2004 and 335?499 in NSS 2014. METHODS:Descriptive statistics, multivariable analyses and a regression decomposition technique were used to attain the study objectives. RESULT:The annual hospitalisation rate per 1000 increased from 16.6 to 37.0 in India from 1995-1996 to 2014. The hospitalisation rate was about half in the less developed than the more developed states in 2014 (26.1 vs 48.6 per 1000). Poor people used more public than private hospitals; this differential was higher in the more developed (40.7% vs 22.9%) than the less developed (54.3% vs 40.1%) states in 2014. When compared with the younger population, the older population had a 3.6 times higher hospitalisation rate (109.9 vs 30.7) and a greater proportion of hospitalisation for non-communicable diseases (80.5% vs 56.7%) in 2014. Among the older population, hospitalisation rates were comparatively lower for females, poor and rural residents. Propensity change contributed to 86.5% of the increase in hospitalisation among the older population and compositional change contributed 9.3%. CONCLUSION:The older population in India has a much higher hospitalisation rate and has continuing greater socioeconomic differentials in hospitalisation rates. Specific policy focus on the requirements of the older population for hospital care in India is needed in light of the anticipated increase in their proportion in the population.

Dataset Information

Hypertension care cascade in Chile: a serial cross-sectional study of national health surveys 2003-2010-2017.

Publications

Hypertension care cascade in Chile: a serial cross-sectional study of national health surveys 2003-2010-2017.

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