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Yang Y, He K, Zhang Y, Wu X, Chen W, Gu D, Zeng Z. Ethnicity Disparities in the Prevalence, Awareness, Treatment, and Control Rates of Hypertension in China. Int J Hypertens 2023; 2023:1432727. [PMID: 36959846 PMCID: PMC10030218 DOI: 10.1155/2023/1432727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 12/23/2022] [Accepted: 03/01/2023] [Indexed: 03/16/2023] Open
Abstract
Objectives Previous studies reported that there were disparities in hypertension management among different ethnic groups, and this study aimed to systematically determine the prevalence, awareness, treatment, and control rates of hypertension in multiple Chinese ethnic groups. Methods We searched Embase, PubMed, and Web of Science for articles up to 25 October, 2022. The pooled prevalence, awareness, treatment, and control rates of hypertension were estimated with 95% confidence intervals (CI). The heterogeneity of estimates among studies was assessed by the Cochran Q test and I 2 statistic. Meta-regression analyses were conducted to identify the factors influencing the heterogeneity of the pooled prevalence, awareness, treatment, and control rate of hypertension. Results In total, 45 publications including 193,788 cases and 587,826 subjects were eligible for the analyses. The lowest prevalence was found in the Han group (27.0%), and the highest prevalence was in the Mongolian population (39.8%). The awareness rates ranged from 24.4% to 58.0% in the four ethnic groups. Both the highest treatment and control rates were found in the Mongolian population (50.6% and 16.0%, respectively), whereas the Yi group had the lowest control rate (8.0%). In addition, the study year, the mean age of subjects, mean body mass index of subjects, tobacco use (%), alcohol use (%), residence (urban%), and education (primary school%) had varied effects on heterogeneity. Conclusions These findings highlight the disparities in prevalence, awareness, treatment, and control rates of hypertension in a different ethnic population of China, which could provide suggestions for making targeted prevention measures.
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Affiliation(s)
- Yanan Yang
- 1Department of Epidemiology and Statistics, Chengdu Medical College, Chengdu 610500, China
| | - Kunlin He
- 2Yibin Center for Disease Control and Prevention, Yibin 644000, China
| | - Yuewen Zhang
- 1Department of Epidemiology and Statistics, Chengdu Medical College, Chengdu 610500, China
| | - Xiuming Wu
- 1Department of Epidemiology and Statistics, Chengdu Medical College, Chengdu 610500, China
| | - Weizhong Chen
- 1Department of Epidemiology and Statistics, Chengdu Medical College, Chengdu 610500, China
| | - Dongqing Gu
- 3First Affiliated Hospital, Army Medical University, Chongqing 400038, China
| | - Ziqian Zeng
- 1Department of Epidemiology and Statistics, Chengdu Medical College, Chengdu 610500, China
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Promise of Physiological Profiling to Prevent Stroke in People of African Ancestry: Prototyping Ghana. Curr Neurol Neurosci Rep 2022; 22:735-743. [PMID: 36181575 DOI: 10.1007/s11910-022-01239-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Worldwide, compared to other racial/ethnic groups, individuals of African ancestry have an excessively higher burden of hypertension-related morbidities, especially stroke. Identifying modifiable biological targets that contribute to these disparities could improve global stroke outcomes. In this scoping review, we discuss how pathological perturbations in the renin-angiotensin-aldosterone pathways could be harnessed via physiological profiling for the purposes of improving blood pressure control for stroke prevention among people of African ancestry. RECENT FINDINGS Transcontinental comparative data from the USA and Ghana show that the prevalence of treatment-resistant hypertension among stroke survivors is 42.7% among indigenous Africans, 16.1% among African Americans, and 6.9% among non-Hispanic Whites, p < 0.0001. A multicenter clinical trial of patients without stroke in 3 African countries (Nigeria, Kenya, and South Africa) demonstrated that physiological profiling using plasma renin activity and aldosterone to individualize selection of antihypertensive medications compared with usual care resulted in better blood pressure control with fewer medications over 12 months. Among Ghanaian ischemic stroke survivors treated without renin-aldosterone profiling data, an analysis revealed that those with low renin phenotypes did not achieve any meaningful reduction in blood pressure over 12 months on 3-4 antihypertensive medications despite excellent adherence. For a polygenic condition such as hypertension, individualized therapy based on plasma renin-aldosterone-guided selection of therapy for uncontrolled BP following precision medicine principles may be a viable strategy for primary and secondary stroke prevention with the potential to reduce disparities in the poor outcomes of stroke disproportionately shared by individuals of African ancestry. A dedicated clinical trial to test this hypothesis is warranted.
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Kuate Defo B, Mbanya JC, Kingue S, Tardif JC, Choukem SP, Perreault S, Fournier P, Ekundayo O, Potvin L, D’Antono B, Emami E, Cote R, Aubin MJ, Bouchard M, Khairy P, Rey E, Richard L, Zarowsky C, Mampuya WM, Mbanya D, Sauvé S, Ndom P, da Silva RB, Assah F, Roy I, Dubois CA. Blood pressure and burden of hypertension in Cameroon, a microcosm of Africa: a systematic review and meta-analysis of population-based studies. J Hypertens 2019; 37:2190-2199. [PMID: 31166251 PMCID: PMC6784854 DOI: 10.1097/hjh.0000000000002165] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/10/2019] [Accepted: 05/08/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To estimate national and geography-based variations in blood pressure and burden of hypertension in Cameroon, generally called 'miniature Africa'. METHODS PubMed, Medline, EMBASE, CINHAL, Web of Science, Popline, Scopus and BDSP were searched through November 2018, for hypertension studies among Cameroonians aged at least 18 years. Hypertension was measured as SBP at least 140 mmHg or DBP at least 90 mmHg. Random-effects meta-analysis was used. RESULTS Twenty studies involving 46 491 participants met inclusion criteria. Overall hypertension prevalence was 30.9% [95% confidence interval (CI) 27.0-34.8]: 29.6% (24.1-35.1) and 32.1% (27.2-37.1) in 1994-2010 and 2011-2018, respectively. Of hypertensive participants, only 24.4% (18.9-30.0) - 31.6% (21.0-42.3) and 20.8% (14.0-27.7) in 1994-2010 and 2011-2018, respectively - were aware of their status, 15.1% (10.6-19.6) were taking antihypertensive medications and 8.8% (5.7-11.9) - 10.4% (7.5-13.3) and 8.3% (4.4-12.3) in 1994-2010 and 2011-2018, respectively - were controlled. Hypertension prevalence varied by sex: 34.3% (30.0-38.6) for men and 31.3% (26.5-36.1) for women; ethnicity: from 3.3% (0.4-6.2) among Pygmies to 56.6% (49.4-63.8) among Bamileke; urbanity: 25.4% (17.1-33.7) for rural and 31.4% (27.3-35.5) for urban dwellers; agroecological zone: from 35.1% (28.9-41.3) in Tropical highlands to 28% (20.1-35.9) in Guinea-Savannah; and subnational region: from 36.3% (27.8-44.9) in the West to 17.1% (9.9-44.2) in the South. CONCLUSION Cameroon's hypertension prevalence is high and increasing whereas awareness, treatment and control are low and declining. Emerging patterns call urgently for effective campaigns to raise hypertension awareness alongside strategies for hypertension prevention and BP control.
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Affiliation(s)
- Barthelemy Kuate Defo
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada
| | - Jean Claude Mbanya
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences
- Laboratory of Molecular Medicine and Metabolism, The Biotechnology Centre, University of Yaoundé I
| | - Samuel Kingue
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences
- Technical Adviser, Ministry of Public Health, Yaoundé, Cameroon
| | - Jean-Claude Tardif
- Montreal Heart Institute
- Deparment of Cardiology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Simeon Pierre Choukem
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | | | - Pierre Fournier
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada
| | - Olugbemiga Ekundayo
- Department of Allied Health, Northern Kentucky University, Highland Heights, Kentucky, USA
| | - Louise Potvin
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada
| | - Bianca D’Antono
- Montreal Heart Institute
- Department of Psychology, Université de Montréal
| | | | - Robert Cote
- Department of Neurology
- Department of Neurosurgery
- Department of Medicine, Faculty of Medicine, McGill University, Montréal
| | | | | | - Paul Khairy
- Montreal Heart Institute
- Deparment of Cardiology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Evelyne Rey
- Department of Obstetrics and Gynecology, Faculty of Medicine
| | | | - Christina Zarowsky
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada
| | - Warner M. Mampuya
- Deparment of Cardiology, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Canada
| | - Dora Mbanya
- Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
| | - Sébastien Sauvé
- Department of Chemistry, Université de Montréal, Montreal, Canada
| | - Paul Ndom
- Department of Radiology and Radiation Oncology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Felix Assah
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences
| | | | - Carl-Ardy Dubois
- Department of Health Administration, Evaluation and Policy, School of Public Health, Université de Montréal, Montreal, Canada
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Dickson DC, Christie SA, Chichom Mefire A, Oben E, Embolo FN, Fonje AN, O'Sullivan P, Akumbu PW, Essi MJ, Dicker R, Juillard C. A Qualitative Study of Transitions Between Health Care Settings After Injury in Cameroon. J Surg Res 2019; 244:528-539. [PMID: 31351396 DOI: 10.1016/j.jss.2019.06.098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/28/2019] [Accepted: 06/25/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Populations in Cameroon, a lower middle-income country in Central Africa, have a higher than average burden of traumatic injury, suffer from more severe injuries, and face substantial barriers to accessing formal health care services after injury. The aim of this study was to identify and describe how recently injured Cameroonians use and adapt the formal and informal medical systems and what motivates these transitions. MATERIALS AND METHODS Recently injured people or their surrogates residing in Southwest Region, Cameroon, were recruited from a larger community-based survey on injury. Semistructured interviews were conducted with 39 recently injured persons or their adult family members. Interviews were recorded, transcribed, and iteratively coded to identify major themes. RESULTS Most injured persons had complex therapeutic itineraries involving one or more transitions, and nine of 35 injured persons used formal care exclusively. Transitions away from formal care were driven by (1) anticipated costs beyond means, (2) unacceptable length of proposed treatment, (3) poorly supported referrals, (4) dissatisfaction with treatment progress or outcome, and (5) belief that traditional methods work additively with formal care. Factors motivating people to engage with formal care included (1) perceived high value of care for cost, (2) desire for reliable diagnostic tests, (3) social support during hospitalization, and (4) financial support from family or a stranger responsible for the injury. CONCLUSIONS These results highlight specific opportunities to improve engagement in formal care after injury and better support injured Cameroonians through the strengthening of the formal care referral process and health financing organization.
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Affiliation(s)
- Drusia C Dickson
- Center for Global Surgical Studies, University of California, San Francisco, San Francisco, California
| | - Sabrinah A Christie
- Center for Global Surgical Studies, University of California, San Francisco, San Francisco, California
| | - Alain Chichom Mefire
- Faculty of Health Sciences, Department of Clinical Sciences, University of Buea, Buea, Southwest Region, Cameroon
| | - Eunice Oben
- Faculty of Health Sciences, Department of Clinical Sciences, University of Buea, Buea, Southwest Region, Cameroon
| | - Frida N Embolo
- Faculty of Health Sciences, Department of Clinical Sciences, University of Buea, Buea, Southwest Region, Cameroon
| | - Ahmed N Fonje
- Faculty of Health Sciences, Department of Clinical Sciences, University of Buea, Buea, Southwest Region, Cameroon
| | - Patricia O'Sullivan
- Department of Medicine and Surgery, University of California San Francisco, San Francisco, California
| | - Pius W Akumbu
- Center for African Languages and Cultures, University of Buea, Buea, Southwest Region, Cameroon
| | - Marie Jose Essi
- Faculty of Medicine and Biomedical Sciences, Department of Public Health, University of Yaounde I, Yaounde, Cameroon
| | - Rochelle Dicker
- Department of Surgery, University of California Los Angeles, Los Angeles, California
| | - Catherine Juillard
- Department of Surgery, University of California Los Angeles, Los Angeles, California.
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Su M, Si Y, Zhou Z, Shen C, Dong W, Fan X, Wang X, Wei X. Comparing the income-related inequity of tested prevalence and self-reported prevalence of hypertension in China. Int J Equity Health 2018; 17:82. [PMID: 29907150 PMCID: PMC6003002 DOI: 10.1186/s12939-018-0796-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 06/04/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Hypertension has become a global health challenge given its high prevalence and but low awareness and detection. Whether the actual prevalence of hypertension has been estimated is important, especially for the poor. This study aimed to measure tested prevalence and self-reported prevalence of hypertension and compare the inequity between them in China. METHODS Data were derived from China Health and Nutrition Survey (CHNS) conducted in 2011. By using the multistage, stratified, random sampling method, 12,168 respondents aged 18 or older were identified for analysis. Both tested prevalence (systolic blood pressure ≥ 140 mmHg or/and diastolic blood pressure ≥ 90 mmHg or /and current use any of antihypertensive medication) and self-reported prevalence (ever diagnosed with hypertension by a doctor) were used to measure the prevalence of hypertension. The concentration index was employed to measure the extent of inequality in tested prevalence and self-reported prevalence. A decomposition method, based on a Probit model, was used to analyze income-related horizontal inequity of tested prevalence and self-reported prevalence. RESULTS The tested prevalence and self-reported prevalence of total respondents were 28.8% [95% CI (28.0%, 29.6%)] and 15.7% [95% CI (15.0%, 16.3%)], and 26.4% [95% CI (25.1%, 27.6%)] and 19.0% [95% CI (17.9%, 20.1%)] in urban areas, and 30.3% [95% CI (29.3%, 31.4%)] and 13.5% [95% CI (12.7%, 14.3%)] in rural areas. The horizontal inequity indexes of mean tested prevalence and self-reported prevalence were - 0.0494 and 0.1203 of total respondents, - 0.0736 and 0.0748 in urban area, and - 0.0177 and 0.0466 in rural area respectively, indicating pro-poor inequity in tested prevalence and pro-rich inequity in self-reported prevalence of hypertension. Economic status, education attainment and age were key factors of the pro-poor inequity in tested prevalence. Economic status, area and age were key factors to explain the poor-rich inequity in self-reported prevalence. CONCLUSIONS This study revealed self-reported prevalence of hypertension was much lower than tested prevalence in China, while a larger gap between self-reported and tested prevalence was found in rural areas. Our study suggested social strategies aiming at narrowing economic gap and regional disparities, reducing educational inequity, and facilitating health conditions of the elderly should be implemented. Finally, awareness raising campaigns to test hypertension in rural area need be strengthened by health education programs and improving the access to public health service, especially for those who do not engage with regular health checkups.
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Affiliation(s)
- Min Su
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Yafei Si
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Chi Shen
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Wanyue Dong
- School of Public Health, Xi’an Jiaotong University, Xi’an, China
| | - Xiaojing Fan
- School of Public Health, Xi’an Jiaotong University, Xi’an, China
| | - Xiao Wang
- International Business School Suzhou, Xi’an Jiaotong-Liverpool University, Suzhou, China
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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