Hypertension Prevalence Rates Among Urban and Rural Older Adults of China, 1991-2015: A Standardization and Decomposition Analysis.

Qi Yu,Shiqi Lin,Jilei Wu

doi:10.3389/fpubh.2021.713730

Abstract

Objectives: The prevalence of hypertension (HTN) among older adults is becoming an important issue in public health in China as it is now stepping into the super-aged society with high pressure of a chronic disease burden. With urban–rural differences in population composition and health facilities, this study aimed to assess the gaps in the prevalence trends of HTN among older adults by considering demographic factors such as age, gender, education level, and regional differences during 1991–2015 in China.Methods: We adopted the consistent sampling design and measure of HTN of the cross-longitudinal surveys of the China Health and Nutrition survey, and we compared the HTN prevalence rates between urban and rural older adults by taking each wave of the survey as a cross-sectional sample of the Chinese population by the following and supplementary samples. The classic standardization and decomposition analysis method was utilized with four factor-specific rates, and contributions were calculated, i.e., age, gender, education, and region, which reflects the aspect of demographic and social development differences between urban and rural areas of China.Results: The prevalence rates of HTN of the whole of older adults were increasing in 1991–2015. However, the gaps of prevalence rates of HTN between urban and rural areas show different trends accompanied by the health policies launched by the government. Namely, the gap was narrowed during 1993–1997 and then enlarged during 1997–2011 and narrowing again. Those trends reflect the policy effects with the health resource allocation and utilization of health services for urban and rural older adults.Conclusions: With the four factors of decomposition analysis, the differences reflect the results of health policy effects, considering the urban–rural discrepancy on older adults with different demographic characteristics. Hence, the differentiated policies should be considered with the urban–rural population, such as HTN prevention and the population health promotion.

Highlights

Hypertension (HTN), as a chronic medical condition in which the blood pressure in the arteries is elevated, is becoming a major threat to population health, especially in older people accompanied with other chronic diseases
This study used data from the China Health and Nutrition Survey (CHNS), which is a national survey on nutritional status, health risk factors, and health status among people aged over 2 years in China
By analyzing the HTN rates of older adults in urban and rural China over the past 25 years from 1991 to 2015, we found that the prevalence of HTN in Chinese older adults was on the rise, and the standardization gaps were not as big as crude rates

Summary

Introduction

Hypertension (HTN), as a chronic medical condition in which the blood pressure in the arteries is elevated, is becoming a major threat to population health, especially in older people accompanied with other chronic diseases. The economic burden of disease caused by HTN accounted for 7.0% of the global disability-adjusted life years (DALYs) in 2010 [1]. Since the beginning of this century, more and more investigations on HTN have been conducted nationwide. From 1991 to 2011, the standardized prevalence of HTN in adults aged 18 years and above increased from 23.9 to 33.6% [2]. The prevalence of HTN of older adults (aged 60 years old and over) was 54.6% [3], which was significantly higher than that in the young population [2]

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Conclusion