Haider Mohammad Rifat, Das Gupta Rajat
Department of Social and Public Health, College of Health Sciences and Professions, Ohio University, Grover Center W333, 1 Ohio University Drive, Athens, OH, 45701, USA.
Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Discovery I, Columbia, SC, 29208, USA.
Int J Cardiol Hypertens. 2020 Mar 15;5:100026. doi: 10.1016/j.ijchy.2020.100026. eCollection 2020 Jun.
With one in every five adults suffering from hypertension and three-fifth of these patients undiagnosed, Nepal faces an enormous problem of undiagnosed hypertension. This study aims to assess the prevalence and determinants of undiagnosed hypertension in Nepal and to examine the extent of socioeconomic inequalities in undiagnosed hypertension in Nepal.
This study used the nationally representative Nepal Demographic and Health Survey 2016 data. Undiagnosed hypertension was defined having systolic blood pressure (SBP) ≥140 mm Hg or diastolic blood pressure (DBP) ≥90 mmHg and being told two or more times by health professionals to lower/control blood pressure. Multiple logistic regression analysis was used for identifying determinants associated with undiagnosed hypertension. Further, socioeconomic inequalities in the prevalence of undiagnosed hypertension were estimated using Concentration Index (CI).
The study results show that out of total 2831 hypertensive patients, 1611 (56.9%) were undiagnosed. In the adjusted model, older age, overweight/obesity, higher wealth quintiles had less odds of being undiagnosed. Male gender and residing in Province 7 had higher odds of being undiagnosed. Overall CI showed that poor patients were disproportionately affected by undiagnosed hypertension (CI: 0.21, Standard Error (SE) of CI: 0.03). The poor (Q1)-to-rich (Q5) ratio was 1.57 showed again that poorest patients in Nepal had higher prevalence of undiagnosed hypertension than richest patients.
Poor patients are disproportionately affected by undiagnosed hypertension in Nepal. Awareness should be created specially among the poor wealth quintiles regarding checking blood pressure regularly. Innovative implementation strategies required to be developed to detect undiagnosed case and provide treatment accordingly.
尼泊尔面临着未确诊高血压这一巨大问题，每五名成年人中就有一人患有高血压，其中五分之三的患者未被诊断出来。本研究旨在评估尼泊尔未确诊高血压的患病率和决定因素，并考察尼泊尔未确诊高血压方面社会经济不平等的程度。
本研究使用了具有全国代表性的2016年尼泊尔人口与健康调查数据。未确诊高血压的定义为收缩压（SBP）≥140毫米汞柱或舒张压（DBP）≥90毫米汞柱，且卫生专业人员曾两次或更多次告知需降低/控制血压。采用多元逻辑回归分析来确定与未确诊高血压相关的决定因素。此外，使用集中指数（CI）估计未确诊高血压患病率方面的社会经济不平等情况。
研究结果显示，在总共2831名高血压患者中，1611名（56.9%）未被诊断出来。在调整后的模型中，年龄较大、超重/肥胖、财富五分位数较高者未被诊断出的几率较低。男性和居住在第7省的人未被诊断出的几率较高。总体集中指数表明，贫困患者受未确诊高血压的影响尤为严重（集中指数：0.21，集中指数的标准误：0.03）。贫困（第一五分位数）与富裕（第五五分位数）的比例为1.57，这再次表明尼泊尔最贫困的患者未确诊高血压的患病率高于最富裕的患者。
在尼泊尔，贫困患者受未确诊高血压的影响尤为严重。应特别提高贫困财富五分位数人群定期检查血压的意识。需要制定创新的实施策略来发现未确诊病例并相应地提供治疗。
