Benade Mariet, Mchiza Zandile, Raquib Rafeya V, Prasad Sridevi K, Yan Lily D, Brennan Alana T, Davies Justine, Sudharsanan Nikkil, Manne-Goehler Jennifer, Fox Matthew P, Bor Jacob, Rosen Sydney B, Stokes Andrew C
Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.
Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa.
PLOS Glob Public Health. 2023 Sep 7;3(9):e0002055. doi: 10.1371/journal.pgph.0002055. eCollection 2023.
Hypertension is a major contributor to global morbidity and mortality. In South Africa, the government has employed a whole systems approach to address the growing burden of non-communicable diseases. We used a novel incident care cascade approach to measure changes in the South African health system's ability to manage hypertension between 2011 and 2017. We used data from Waves 1-5 of the National Income Dynamics Study (NIDS) to estimate trends in the hypertension care cascade and unmet treatment need across four successive cohorts with incident hypertension. We used a negative binomial regression to identify factors that may predict higher rates of hypertension control, controlling for socio-demographic and healthcare factors. In 2011, 19.6% (95%CI 14.2, 26.2) of individuals with incident hypertension were diagnosed, 15.4% (95%CI 10.8, 21.4) were on treatment and 7.1% had controlled blood pressure. By 2017, the proportion of individuals with diagnosed incident hypertension had increased to 24.4% (95%CI 15.9, 35.4). Increases in treatment (23.3%, 95%CI 15.0, 34.3) and control (22.1%, 95%CI 14.1, 33.0) were also observed, translating to a decrease in unmet need for hypertension care from 92.9% in 2011 to 77.9% in 2017. Multivariable regression showed that participants with incident hypertension in 2017 were 3.01 (95%CI 1.77, 5.13) times more likely to have a controlled blood pressure compared to those in 2011. Our data show that while substantial improvements in the hypertension care cascade occurred between 2011 and 2017, a large burden of unmet need remains. The greatest losses in the incident hypertension care cascades came before diagnosis. Nevertheless, whole system programming will be needed to sufficiently address significant morbidity and mortality related to having an elevated blood pressure.
高血压是全球发病和死亡的主要原因。在南非，政府采用了一种全系统方法来应对日益加重的非传染性疾病负担。我们使用了一种新颖的发病护理级联方法来衡量2011年至2017年间南非卫生系统管理高血压能力的变化。我们利用国民收入动态研究（NIDS）第1-5轮的数据，估计了四个连续高血压发病队列中高血压护理级联和未满足治疗需求的趋势。我们使用负二项回归来确定可能预测更高高血压控制率的因素，并控制社会人口统计学和医疗保健因素。2011年，19.6%（95%CI 14.2, 26.2）的高血压发病个体被诊断出来，15.4%（95%CI 10.8, 21.4）接受了治疗，7.1%的人血压得到控制。到2017年，已诊断出的高血压发病个体比例增至24.4%（95%CI 15.9, 35.4）。治疗（23.3%，95%CI 15.0, 34.3）和控制（22.1%，95%CI 14.1, 33.0）也有所增加，这使得高血压护理未满足需求从2011年的92.9%降至2017年的77.9%。多变量回归显示，2017年高血压发病参与者血压得到控制的可能性是2011年参与者的3.01倍（95%CI 1.77, 5.13）。我们的数据表明，虽然2011年至2017年间高血压护理级联有了显著改善，但仍有大量未满足的需求。高血压发病护理级联中最大的损失发生在诊断之前。然而，仍需要全系统规划来充分解决与血压升高相关的重大发病和死亡问题。
