Wand Handan, Moodley Jayajothi, Reddy Tarylee, Vujovich-Dunn Cassandra, Naidoo Sarita
Kirby Institute, University of New South Wales, Kensington, 2052, New South Wales, Australia.
The Aurum Institute, Johannesburg, South Africa.
Prev Med. 2022 Oct;163:107222. doi: 10.1016/j.ypmed.2022.107222. Epub 2022 Aug 24.
South Africa has one of the world's highest proportions of hypertensive individuals, which has become a major public health problem. Understanding the temporal and spatial patterns in hypertension rates is crucial for evaluating the existing prevention and care models, which have not been fully understood in South Africa. The geoadditive models were used to quantify the geographical clustering of hypertension in the Black South African population enrolled in the most recent cross-sectional national surveys (2008-2017). Population-attributable risks were calculated for modifiable risk factors. 80,270 men (41%) and women (59%) aged 15+ were included. Using the 2017 guidelines, 52% of the men and 51% of the women were classified as hypertensive. As expected, these proportions were slightly lower when we used the previous guidelines (48% and 47% for men and women, respectively). There was significant geospatial heterogeneity in hypertension prevalence with substantial province-specific disparities. Western, Northern, and Eastern Capes were the most significant provinces, with >50% of the hypertensive men and women. The population-level impact of obesity remained high in all provinces, where 33%-to-57% and 47%-to-65% of hypertensives were exclusively associated with obese/overweight men and women respectively. Despite some improvements in certain areas, most of the country is behind the targeted levels set in 2011/2013. Identifying the most relevant risk factors and their sub-geographical-level contributions to hypertension may have significant public health implications for developing and implementing cost-effective prevention programs to raise awareness of healthy diet and lifestyle behaviours.
南非高血压患者比例位居世界前列，这已成为一个重大的公共卫生问题。了解高血压发病率的时空模式对于评估现有的预防和护理模式至关重要，而南非对这些模式尚未完全理解。地理加性模型用于量化参与最近一次全国横断面调查（2008 - 2017年）的南非黑人高血压患者的地理聚集情况。计算了可改变风险因素的人群归因风险。纳入了80270名15岁及以上的男性（41%）和女性（59%）。根据2017年指南，52%的男性和51%的女性被归类为高血压患者。不出所料，当我们使用之前的指南时，这些比例略低（男性和女性分别为48%和47%）。高血压患病率存在显著的地理空间异质性，各省份之间存在较大差异。西开普省、北开普省和东开普省是最为显著的省份，高血压男性和女性比例均超过50%。肥胖对所有省份的人群层面影响仍然很高，分别有33%至57%的男性高血压患者和47%至65%的女性高血压患者完全与肥胖/超重有关。尽管某些领域有所改善，但该国大部分地区仍未达到2011/2013年设定的目标水平。确定最相关的风险因素及其在亚地理层面上对高血压的影响，对于制定和实施具有成本效益的预防计划以提高对健康饮食和生活方式行为的认识可能具有重大的公共卫生意义。
