Lee Hokyou, Park Sungha, Kim Hyeon Chang
Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Korean Circ J. 2019 Jun;49(6):514-527. doi: 10.4070/kcj.2018.0358. Epub 2019 Feb 14.
Geographic distribution of hypertension management in Korea has never been reported. We investigated temporal and regional trends of hypertension management in Korea.
For each calendar year from 2002 to 2016, we identified 2,423,245 to 7,549,989 persons aged ≥30 years treated for hypertension (total 80,564,109 cases). We calculated yearly age-sex standardized rates for medication adherence, combination therapy, blood test, and urine test according to geographic regions. We then used multivariate logistic regression to calculate odds ratios for hypertension management adjusted for individual-level sociodemographic factors.
Adherence rates have markedly increased from 24.4% (2002) to 71.6% (2016) nationwide. Regional difference was prominent in 2002 (highest, 31.7% in Seoul; lowest, 14.4% in Jeonbuk), but has become less noticeable over 15 years (highest, 73.1% in Daejeon; lowest, 69.0% in Jeonnam, 2016). Combination therapy rates increased from 42.8% (2002) to 61.0% (2011), but are in decreasing trend after 2011. Blood test rates were 58.8% in 2016, whereas urine test rates have been stagnant below 50% across all regions. Geographic variations of combination therapy and complication screening rates were not profound. Results from multivariable logistic regression, adjusted for age and sex, were in agreement with trends observed by standardized rates. The odds ratios remained unchanged when the models were further adjusted for employment status and household income.
Regional difference in hypertension management was evident in the past, but has become less apparent over the last 15 years in Korea.
韩国高血压管理的地理分布情况此前从未有过报道。我们对韩国高血压管理的时间和地区趋势进行了调查。
对于2002年至2016年的每一个日历年，我们确定了2423245至7549989名年龄≥30岁接受高血压治疗的患者（共计80564109例）。我们根据地理区域计算了药物依从性、联合治疗、血液检查和尿液检查的年度年龄-性别标准化率。然后，我们使用多变量逻辑回归来计算经个体层面社会人口学因素调整后的高血压管理比值比。
全国范围内，依从率已从2002年的24.4%显著提高至2016年的71.6%。2002年地区差异显著（最高的是首尔，为31.7%；最低的是全北，为14.4%），但在15年里这种差异变得不那么明显了（2016年最高的是大田，为73.1%；最低的是全南，为69.0%）。联合治疗率从2002年的42.8%提高到2011年的61.0%，但在2011年之后呈下降趋势。2016年血液检查率为58.8%，而尿液检查率在所有地区一直停滞在50%以下。联合治疗和并发症筛查率的地理差异并不显著。经年龄和性别调整后的多变量逻辑回归结果与标准化率观察到的趋势一致。当模型进一步根据就业状况和家庭收入进行调整时，比值比保持不变。
过去韩国高血压管理存在地区差异，但在过去15年里这种差异已变得不那么明显。
