Research Department of Epidemiology and Public Health, UCL.
NatCen Social Research, London, UK.
J Hypertens. 2020 May;38(5):912-924. doi: 10.1097/HJH.0000000000002350.
To quantify income-based inequalities in hypertension and in undiagnosed hypertension.
We used nationally representative data from 28 002 adults (aged 16 years and older) living in private households who participated in the cross-sectional Health Survey for England 2011-2016. Using bivariate probit regression modelling, we jointly modelled hypertension and self-reported previous diagnosis of hypertension by a doctor or nurse. We then used the model estimates to quantify inequalities in undiagnosed hypertension. Inequalities, using household income tertiles as an indicator of socioeconomic status, were quantified using average marginal effects (AMEs) after adjustment for confounding variables.
Overall, 32% of men and 27% of women had survey-defined hypertension (measured blood pressure ≥140/90 mmHg and/or currently using medicine to treat high blood pressure). Higher proportions (38% of men and 32% of women) either self-reported previous diagnosis or had survey-defined hypertension. Of these, 65% of men and 70% of women had diagnosed hypertension. Among all adults, participants in low-income versus high-income households had a higher probability of being hypertensive [AMEs: men 2.1%; 95% confidence interval (CI): -0.2, 4.4%; women 3.7%; 95% CI: 1.8, 5.5%] and of being diagnosed as hypertensive (AMEs: men 2.0%; 95% CI: 0.4, 3.7%; women 2.5%; 95% CI: 1.1, 3.9%). Among those classed as hypertensive, men in low-income households had a marginally lower probability of being undiagnosed than men in high-income households (AME: -5.2%; 95% CI: -10.5, 0.1%), whereas no difference was found among women.
Our findings suggest that income-based inequalities in hypertension coexist with equity in undiagnosed hypertension.
量化高血压和未确诊高血压的收入不平等。
我们使用了来自 28002 名居住在私人住宅中的成年人（年龄在 16 岁及以上）的全国代表性数据，这些成年人参加了 2011-2016 年的英格兰健康调查。我们使用双变量概率回归模型，共同构建了高血压和自我报告的医生或护士先前诊断的高血压模型。然后，我们使用模型估计来量化未确诊高血压的不平等。使用家庭收入三分位数作为社会经济地位的指标，在调整混杂变量后，使用平均边际效应（AME）来量化不平等。
总体而言，32%的男性和 27%的女性患有调查定义的高血压（测量血压≥140/90mmHg 和/或目前正在服用治疗高血压的药物）。更高比例（38%的男性和 32%的女性）自我报告了以前的诊断或患有调查定义的高血压。其中，65%的男性和 70%的女性患有确诊的高血压。在所有成年人中，低收入家庭的参与者比高收入家庭的参与者更有可能患有高血压[AME：男性 2.1%；95%置信区间（CI）：-0.2，4.4%；女性 3.7%；95%CI：1.8，5.5%]和被诊断为高血压（AME：男性 2.0%；95%CI：0.4，3.7%；女性 2.5%；95%CI：1.1，3.9%）。在被归类为高血压的人群中，低收入家庭的男性被诊断为未确诊的可能性略低于高收入家庭的男性（AME：-5.2%；95%CI：-10.5，0.1%），而女性则没有差异。
我们的研究结果表明，高血压的收入不平等与未确诊高血压的公平性并存。
