International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Bangladesh.
Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, 171 77, Sweden.
Int J Equity Health. 2019 Feb 15;18(1):33. doi: 10.1186/s12939-019-0930-5.
In recent years, developing countries like Bangladesh are facing a higher burden of non-communicable diseases such as hypertension as a result of demographic transition. Prevalence of hypertension is often studied in this setting. However, evidence on undiagnosed hypertension is not widely available in the existing literature. Therefore, the current study focuses on inequalities in the prevalence of undiagnosed hypertension in Bangladesh.
A total of 8835 participants aged 35+ years were included in this study using nationally representative Bangladesh Demographic and Health Survey 2011 (BDHS). In the survey, systolic blood pressure (SBP) and diastolic blood pressure (DBP) of these participants were measured three times with approximately 10 minutes of an interval between each measurement. Any respondent with either SBP ≥ 140 mmHg or DBP ≥ 90 mmHg was considered as patient with hypertension as per the guidelines from American Heart Association. Among the participants, undiagnosed hypertension was defined as having SBP > =140 mmHg or DBP > =90 mmHg and never taking prescribed medicine or being told by health professionals to lower/control blood pressure. Multiple logistic regression analysis was applied for identifying factors associated with undiagnosed hypertension. Further, socioeconomic inequalities in the prevalence of undiagnosed hypertension were estimated using Concentration Index (C).
We found 978 (59.9% of the total) were undiagnosed among 1685 hypertensive patients studied. Regression analysis showed individuals with being underweight, having poor socioeconomic conditions, and lower educational qualifications were more likely to have undiagnosed hypertension. A similar association between undiagnosed hypertension and socioeconomic quintiles was observed using concentration index (C = - 0.07). On the other hand, individuals from higher age group (50-64 or above), female sex, and Sylhet region were at lower risk of undiagnosed hypertension.
This study showed that a large proportion of the cases with hypertension are remained undiagnosed in Bangladesh, especially among the poor and low educated population. Screening and awareness building initiatives on hypertension should be taken for this group of population to reduce the burden of undiagnosed hypertension.
近年来，由于人口结构的转变，孟加拉国等发展中国家面临着更高的非传染性疾病（如高血压）负担。在这种情况下，高血压的患病率经常被研究。然而，现有的文献中并没有广泛提供未确诊高血压的证据。因此，本研究重点关注孟加拉国未确诊高血压的患病率不平等问题。
本研究共纳入了 8835 名年龄在 35 岁及以上的参与者，使用了具有全国代表性的 2011 年孟加拉国人口与健康调查（BDHS）。在调查中，这些参与者的收缩压（SBP）和舒张压（DBP）每 10 分钟测量一次，共测量三次。根据美国心脏协会的指南，任何 SBP≥140mmHg 或 DBP≥90mmHg 的受访者均被视为高血压患者。在这些参与者中，未确诊的高血压定义为 SBP≥140mmHg 或 DBP≥90mmHg，且从未服用过规定的药物或从未被告知降低/控制血压。应用多因素逻辑回归分析确定与未确诊高血压相关的因素。此外，使用集中指数（C）估计未确诊高血压的患病率在社会经济方面的不平等。
我们发现，在所研究的 1685 名高血压患者中，有 978 名（占总数的 59.9%）为未确诊患者。回归分析表明，体重过轻、社会经济条件差和受教育程度低的个体更有可能患有未确诊的高血压。使用集中指数（C=-0.07）也观察到未确诊高血压与社会经济五分位数之间的类似关联。另一方面，年龄较大的（50-64 岁或以上）、女性和锡尔赫特地区的个体患未确诊高血压的风险较低。
本研究表明，孟加拉国大量高血压患者未被确诊，尤其是在贫困和受教育程度较低的人群中。应该为这一人群开展高血压筛查和提高认识的活动，以减少未确诊高血压的负担。
