Berry Kaitlyn M, Parker Whadi-Ah, Mchiza Zandile J, Sewpaul Ronel, Labadarios Demetre, Rosen Sydney, Stokes Andrew
Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA.
Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, South Africa.
BMJ Glob Health. 2017 Aug 16;2(3):e000348. doi: 10.1136/bmjgh-2017-000348. eCollection 2017.
Hypertension has become a major cause of morbidity and premature mortality in South Africa, but population-wide estimates of prevalence and access to care are scarce. Using data from the South African National Health and Nutrition Examination Survey (2011-2012), this analysis evaluates the national prevalence of hypertension and uses a care cascade to examine unmet need for care.
Hypertension was defined as blood pressure over 140/90 mm Hg or use of antihypertensive medication. We constructed a hypertension care cascade by decomposing the population with hypertension into five mutually exclusive and exhaustive subcategories: (1) unscreened and undiagnosed, (2) screened but undiagnosed, (3) diagnosed but untreated, (4) treated but uncontrolled and (5) treated and controlled. Multivariable logistic regression models were used to explore factors associated with hypertension prevalence and diagnosis.
In South Africans aged 15 and above, the age standardised prevalence of hypertension was 35.1%. Among those with hypertension, 48.7% were unscreened and undiagnosed, 23.1% were screened but undiagnosed, 5.8% were diagnosed but untreated, 13.5% were treated but uncontrolled and 8.9% were controlled. The hypertension care cascade demonstrates that 49% of those with hypertension were lost at the screening stage, 50% of those who were screened never received a diagnosis, 23% of those who were diagnosed did not receive treatment and 48% of those who were treated did not reach the threshold for control. Men and older individuals had increased risks of being undiagnosed after controlling for other factors.
There is significant unmet need for hypertension care in South Africa; 91.1% of the hypertensive population was unscreened, undiagnosed, untreated or uncontrolled. Data from this study provide insight into where patients are lost in the hypertension care continuum and serve as a benchmark for evaluating efforts to manage the rising burden of hypertension in South Africa.
高血压已成为南非发病和过早死亡的主要原因，但缺乏全国范围内高血压患病率及医疗服务可及性的评估数据。本分析利用南非国家健康与营养检查调查（2011 - 2012年）的数据，评估全国高血压患病率，并采用医疗服务级联模型来研究未满足的医疗需求。
高血压定义为血压超过140/90 mmHg或正在使用降压药物。我们通过将高血压人群分解为五个相互排斥且详尽无遗的子类别，构建了一个高血压医疗服务级联模型：（1）未筛查且未诊断；（2）已筛查但未诊断；（3）已诊断但未治疗；（4）已治疗但未控制；（5）已治疗且已控制。使用多变量逻辑回归模型来探究与高血压患病率及诊断相关的因素。
在15岁及以上的南非人中，年龄标准化的高血压患病率为35.1%。在高血压患者中，48.7%未筛查且未诊断，23.1%已筛查但未诊断，5.8%已诊断但未治疗，13.5%已治疗但未控制，8.9%已治疗且已控制。高血压医疗服务级联模型表明，49%的高血压患者在筛查阶段流失，50%已筛查的患者从未得到诊断，23%已诊断的患者未接受治疗，48%已治疗的患者未达到控制标准。在控制其他因素后，男性和年长者未被诊断的风险增加。
南非存在对高血压医疗服务的重大未满足需求；91.1%的高血压人群未接受筛查、未被诊断、未接受治疗或未得到控制。本研究数据深入了解了患者在高血压医疗服务连续过程中的流失环节，并为评估南非应对不断上升的高血压负担所做努力提供了一个基准。
