Health Administration and Policy Department, Faculty of Public Health, Universitas Indonesia, Depok 16424, Indonesia.
Department of Health Services Research and Management, School of Health & Psychological Sciences, City University of London, London EC1V 0HB, UK.
Int J Environ Res Public Health. 2022 Oct 14;19(20):13268. doi: 10.3390/ijerph192013268.
An estimated 1.28 billion adults 30-79 years old had hypertension globally in 2021, of which two-thirds lived in low- and middle-income countries (LMICs). Previous studies on geographic and socioeconomic inequalities in hypertension among adults have limitations: (a) most studies used individual-level data, while evidence from locality-level data is also crucial for policymaking; (b) studies from LMICs are limited. Thus, our study examines geographic and socioeconomic inequalities in hypertension among adults across districts in Indonesia.
We combined geospatial and quantitative analyses to assess the inequalities in hypertension across 514 districts in Indonesia. Hypertension data were obtained from the Indonesian Basic Health Survey (Riskesdas) 2018. Socioeconomic data were obtained from the World Bank. Six dependent variables included hypertension prevalence among all adults (18+ years), male adults, female adults, young adults (18-24 years), adults (25-59 years), and older adults (60+ years).
We also found significant geographic and socioeconomic inequalities in hypertension among adults across 514 districts. All hypertension indicators were higher in the most developed region than in the least developed region. Districts in the Java region had up to 50% higher prevalence of hypertension among all adults, males, females, young adults, adults, and older adults. Notably, districts in the Kalimantan region had the highest prevalence of hypertension, even compared to those in Java. Moreover, income level was positively associated with hypertension; the wealthiest districts had higher hypertension than the poorest districts by up to 30%, but only among males and older adults were statistically significant.
There were significant inequalities in hypertension among adults across 514 districts in the country. Policies to reduce such inequalities may need to prioritize more affluent urban areas and rural areas with a higher burden.
据估计，2021 年全球有 12.8 亿 30-79 岁成年人患有高血压，其中三分之二生活在中低收入国家（LMICs）。先前关于成年人高血压的地理和社会经济不平等的研究存在局限性：（a）大多数研究使用个体层面的数据，而来自地方层面的数据证据对于决策制定也至关重要；（b）来自 LMICs 的研究有限。因此，我们的研究考察了印度尼西亚各地区成年人高血压的地理和社会经济不平等。
我们结合地理空间和定量分析，评估了印度尼西亚 514 个地区成年人高血压的不平等情况。高血压数据来自 2018 年印度尼西亚基本健康调查（Riskesdas）。社会经济数据来自世界银行。六个因变量包括所有成年人（18 岁以上）、成年男性、成年女性、青年成年人（18-24 岁）、成年成年人（25-59 岁）和老年成年人（60 岁以上）的高血压患病率。
我们还发现，514 个地区成年人高血压存在显著的地理和社会经济不平等。所有高血压指标在最发达地区都高于最不发达地区。爪哇地区的所有成年人、男性、女性、青年成年人、成年成年人和老年成年人的高血压患病率都高达 50%。值得注意的是，加里曼丹地区的高血压患病率最高，甚至高于爪哇地区。此外，收入水平与高血压呈正相关；最富裕的地区比最贫穷的地区高血压患病率高 30%，但仅在男性和老年成年人中具有统计学意义。
该国 514 个地区成年人高血压存在显著不平等。减少这种不平等的政策可能需要优先考虑富裕的城市地区和负担较重的农村地区。
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