Prevention Research Center, Centers for Health Policy, Primary Care, and Outcomes Research, Center on Poverty and Inequality, Stanford University, Stanford, CA, USA.
Hypertension. 2013 Jul;62(1):18-26. doi: 10.1161/HYPERTENSIONAHA.113.01374. Epub 2013 May 13.
Large-scale hypertension screening campaigns have been recommended for middle-income countries. We sought to identify sociodemographic predictors of hypertension prevalence, diagnosis, treatment, and control among middle-income countries. We analyzed data from 47 443 adults in all 6 middle-income countries (China, Ghana, India, Mexico, Russia, and South Africa) sampled in nationally representative household assessments from 2007 to 2010 as part of the World Health Organization Study on Global Aging and Adult Health. We estimated regression models accounting for age, sex, urban/rural location, nutrition, and obesity, as well as hypothesized covariates of healthcare access, such as income and insurance. Hypertension prevalence varied from 23% (India) to 52% (Russia), with between 30% (Russia) and 83% (Ghana) of hypertensives undiagnosed before the survey and between 35% (Russia) and 87% (Ghana) untreated. Although the risk of hypertension significantly increased with age (odds ratio, 4.6; 95% confidence interval, 3.0-7.1; among aged, 60-79 versus <40 years), the risk of being undiagnosed or untreated fell significantly with age. Obesity was a significant correlate to hypertension (odds ratio, 3.7; 95% confidence interval, 2.1-6.8 for obese versus normal weight), and was prevalent even among the lowest income quintile (13% obesity). Insurance status and income also emerged as significant correlates to diagnosis and treatment probability, respectively. More than 90% of hypertension cases were uncontrolled, with men having 3 times the odds as women of being uncontrolled. Overall, the social epidemiology of hypertension in middle-income countries seems to be correlated to increasing obesity prevalence, and hypertension control rates are particularly low for adult men across distinct cultures.
大规模高血压筛查活动已被推荐用于中等收入国家。我们旨在确定中等收入国家高血压患病率、诊断、治疗和控制的社会人口学预测因素。我们分析了来自六个中等收入国家（中国、加纳、印度、墨西哥、俄罗斯和南非）的 47443 名成年人的数据，这些成年人是 2007 年至 2010 年期间在全国代表性家庭评估中抽样的，作为世界卫生组织全球老龄化和成人健康研究的一部分。我们估计了考虑年龄、性别、城乡位置、营养和肥胖的回归模型，以及医疗保健获取的假设协变量，如收入和保险。高血压患病率从 23%（印度）到 52%（俄罗斯）不等，在调查前，有 30%（俄罗斯）到 83%（加纳）的高血压患者未被诊断，有 35%（俄罗斯）到 87%（加纳）的高血压患者未得到治疗。尽管随着年龄的增长，患高血压的风险显著增加（优势比，4.6；95%置信区间，3.0-7.1；60-79 岁年龄组与<40 岁年龄组相比），但未被诊断或未得到治疗的风险随着年龄的增长而显著下降。肥胖是高血压的一个显著相关因素（肥胖者的优势比，3.7；95%置信区间，2.1-6.8 与正常体重者相比），即使在收入最低的五分位数（肥胖率为 13%）中也很普遍。保险状况和收入也分别成为诊断和治疗概率的显著相关因素。超过 90%的高血压病例未得到控制，男性未得到控制的几率是女性的 3 倍。总的来说，中等收入国家高血压的社会流行病学似乎与肥胖患病率的上升有关，而且不同文化背景的成年男性的高血压控制率特别低。
