Yichong Li1,2, Limin Wang1, Xiaoqi Feng3,4,5, Mei Zhang1, Zhengjing Huang1, Qian Deng1, Maigeng Zhou1, Thomas Astell-Burt3,4,5, Linhong Wang1. 1. National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention. 2. Peking University Clinical Research Institute, Beijing, China. 3. Population Wellbeing and Environment Research Lab, School of Health and Society. 4. Early Start Research Institute, Faculty of Social Sciences. 5. Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia.
Abstract
OBJECTIVES: Hypertension has been the most important risk factor for disease burden in China. We aimed to conduct the first national spatial analysis of hypertension status, awareness, treatment and control in China. METHODS: Choropleth maps were used to examine the spatial patterning of hypertension, awareness, treatment and control in a nationally and provincially representative sample of 174 389 adults from the 2013 to 2014 China Chronic Disease and Risk Factors Surveillance. Multilevel regressions were used to analyze each outcome across provinces, counties, towns and villages/residential committees and to test the proportion of area-level variances explained by known risk factors. RESULTS: Hypertension prevalence was highest in the north (e.g. Liaoning = 37.7%) and lowest in the south (e.g. Hainan = 17.9%). Among participants found to have hypertension, awareness was generally low, especially in the south (e.g. Guizhou = 18.0%). Receipt of treatment among those who were aware of their hypertension status was above 70% in all provinces except for Tibet (37.7%) and Guizhou (54.5%). Control of hypertension among those receiving treatment (SBP < 140 and DBP < 90 mmHg) was generally low, especially in northeastern and southwestern provinces. Adjustment for demographic, socioeconomic and behavioral factors, weight status, healthcare use and urbanization of residence accounted for 57.7% of variation between provinces in hypertension status, 48.5% in awareness, 47.6% in treatment and 18.0% in control. CONCLUSION: Hypertension is spatially patterned in China and there is an unmet need at each step from diagnosis to receiving treatment and achieving controlled hypertension. Geographically targeted strategies are required to enhance hypertension prevention and management in China.
OBJECTIVES:Hypertension has been the most important risk factor for disease burden in China. We aimed to conduct the first national spatial analysis of hypertension status, awareness, treatment and control in China. METHODS: Choropleth maps were used to examine the spatial patterning of hypertension, awareness, treatment and control in a nationally and provincially representative sample of 174 389 adults from the 2013 to 2014 China Chronic Disease and Risk Factors Surveillance. Multilevel regressions were used to analyze each outcome across provinces, counties, towns and villages/residential committees and to test the proportion of area-level variances explained by known risk factors. RESULTS:Hypertension prevalence was highest in the north (e.g. Liaoning = 37.7%) and lowest in the south (e.g. Hainan = 17.9%). Among participants found to have hypertension, awareness was generally low, especially in the south (e.g. Guizhou = 18.0%). Receipt of treatment among those who were aware of their hypertension status was above 70% in all provinces except for Tibet (37.7%) and Guizhou (54.5%). Control of hypertension among those receiving treatment (SBP < 140 and DBP < 90 mmHg) was generally low, especially in northeastern and southwestern provinces. Adjustment for demographic, socioeconomic and behavioral factors, weight status, healthcare use and urbanization of residence accounted for 57.7% of variation between provinces in hypertension status, 48.5% in awareness, 47.6% in treatment and 18.0% in control. CONCLUSION:Hypertension is spatially patterned in China and there is an unmet need at each step from diagnosis to receiving treatment and achieving controlled hypertension. Geographically targeted strategies are required to enhance hypertension prevention and management in China.