Abstract
BackgroundThis study examines trends and geographic disparities in the diagnosis, treatment, and control of hypertension in China and investigates the association between regional factors and hypertension care.MethodsBlood pressure data and data relating to health care for hypertension were used for this study. The data were sourced from baseline and follow-up surveys of the China Health and Retirement Longitudinal Study, which was conducted in 2011, 2013, and 2015. To estimate the geographical disparities in diagnosis, treatment, and control of hypertension, random-effects models were also applied after controlling for sociodemographic characteristics.ResultsAmong hypertensive individuals in China, the trends showed decreases in undiagnosed, untreated, and uncontrolled hypertension: 44.1%, 51.6%, and 80.7% in 2011; 40.0%, 47.4%, and 77.8% in 2013; and 31.7%, 38.0%, and 71.4% in 2015, respectively. The number of undiagnosed, untreated, and uncontrolled hypertensive residents living in urban areas in 2015 was more than 10% lower than the number in rural areas and among rural-to-urban immigrant individuals in China. The poorest socio-economic regions across China were 8.5 times more likely to leave their residents undiagnosed, 2.8 times more likely to leave them untreated, and 2.6 times more likely to leave hypertension uncontrolled.ConclusionsAlthough China has made impressive progress in addressing regional inequalities in hypertension care over time, it needs to increase its effort to reduce geographic disparities and to provide more effective treatments and higher quality care for patients with hypertension.
Highlights
In an era of sustainable development goals, advancing universal health coverage is the centerpiece of health policy in many countries.[1,2] Like most countries in the world, China has recently experienced a very rapid epidemiological transition from a predominance of infectious disease to a predominance of chronic non-communicable diseases (NCDs), including cardiovascular diseases, stroke, diabetes, and cancers.[3]
The design of China Health and Retirement Longitudinal Study (CHARLS) was based on the Health and Retirement Study (HRS)[16] and related ageing surveys, such as the English Longitudinal Study of Aging (ELSA)[17] and the Survey of Health, Aging and Retirement in Europe (SHARE).[18]
The number of undiagnosed, untreated, and uncontrolled hypertensive residents living in urban areas in 2015 was more than 10% lower than the number of patients in rural areas and among rural-to-urban immigrant individuals with hypertension in China (Table 1)
Summary
In an era of sustainable development goals, advancing universal health coverage is the centerpiece of health policy in many countries.[1,2] Like most countries in the world, China has recently experienced a very rapid epidemiological transition from a predominance of infectious disease to a predominance of chronic non-communicable diseases (NCDs), including cardiovascular diseases, stroke, diabetes, and cancers.[3] Hypertension has been a leading risk factor for NCDs and disease burden in China.[4,5,6] As an effective response, the government of China launched a new comprehensive health reform initiative in 2009 aimed at increasing population access to health services, reducing the financial burden of illness, and achieving universal health care (UHC).[4,7] As one of five major projects comprising the reform, the National Public Health Service Equalisation (PHSE) Program sought to improve health equity and extend access to primary public health services. This study examines trends and geographic disparities in the diagnosis, treatment, and control of hypertension in China and investigates the association between regional factors and hypertension care
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