Association between Undiagnosed Hypertension and Health Factors among Middle-Aged and Elderly Chinese Population

Decomposition analysis on the equity of health examination utilization for the middle-aged and elderly people in China: based on longitudinal CHARLS data from 2011 to 2018

BACKGROUND

This study aimed to investigate the utilization rate and equity of health examination service among the middle-aged and elderly population in China from 2011 to 2018. The contribution of various determinants to the inequity in health examination service utilization was also examined.

METHODS

Data from the China Health and Retirement Longitudinal Survey (CHARLS) were analyzed to assess the health examination service utilization rate among the middle-aged and elderly population. A concentration curve and concentration index were employed to measure the equity of health examination service utilization and decomposed into its determining factors. Horizontal inequity index was applied to evaluate the trends in equity of health examination service.

RESULTS

The health examination service utilization rates among the middle-aged and elderly population were 29.45%, 20.69%, 25.40%, and 32.05% in 2011, 2013, 2015, and 2018, respectively. The concentration indexes for health examination service utilization were 0.0080 (95% CI: - 0.0084, 0.0244), 0.0155 (95% CI: - 0.0054, 0.0363), 0.0095 (95% CI: - 0.0088, 0.0277), and - 0.0100 (95% CI: - 0.0254, 0.0054) from 2011 to 2018, respectively. The horizontal inequity index was positive from 2011 to 2018, evidencing a pro-rich inequity trend. Age, residence, education, region, and economic status were the major identified contributors influencing the equity of health examination service utilization.

CONCLUSIONS

A pro-rich inequity existed in health examination service utilization among the middle-aged and elderly population in China. Reducing the wealth and regional gap, providing equal educational opportunities, and strengthening the capacity for chronic disease prevention and control are crucial for reducing the inequity in health examination service utilization.

Factors associated with undiagnosed hypertension among Tongan adults: a cross-sectional study

BACKGROUND

Hypertension is responsible for many premature deaths worldwide. However, many individuals with hypertension remain undiagnosed. Tonga is one of the countries that has had a steep increase in hypertension, thus undiagnosed hypertension could also be increasing. Purpose of this study was to assess the prevalence and factors associated with undiagnosed hypertension among Tongan adults.

METHODS

This cross-sectional study used data collected from conveniently sampled 473 participants using electronic questionnaire and digital sphygmomanometer through household visits between February and March 2023. Inclusion criteria were age of 18-65 years, residence in the villages for at least six months, and not being pregnant. Fisher's exact test and mixed-effect logistic regression were performed using the EZR software to assess the association between undiagnosed hypertension and predictor variables.

RESULTS

The prevalence of undiagnosed hypertension was 22.4% (106/473). Five variables that were significantly associated with undiagnosed hypertension in Fisher's exact test were included in the multivariate logistic regression. Overall, only three variables remained significant. First, participants who never had their blood pressure measured had higher prevalence compared to those who had it checked recently (33.3% vs. 19.1%); odds ratio: 2.24). Secondly, participants who were not aware of the risk of developing hypertension were significantly more likely to have undiagnosed hypertension compared to those who were aware (27.9% vs. 16.7%; odds ratio: 1.81). Lastly, middle-aged participants (30-49 years) and older (50-65 years), were significantly more likely to have undiagnosed hypertension compared to those who were 18-29 years old (30.0% and 23.7% vs. 11.8%; odds ratio: 3.58 and 3.38 vs. 1.00).

CONCLUSION

The prevalence of undiagnosed hypertension could be substantial among Tongan adults, implicating a need to address this issue by doing further research and review current public health work to address hypertension in Tonga. Undiagnosed hypertension was associated with having no experience of blood pressure measurement, lack of awareness about hypertension, and age. Tongan government should provide people with more opportunities to have their blood pressure measured and to improve their awareness.

Undiagnosed hypertension and its associated factors in Ethiopia: A systematic review and meta-analysis

Background and Aims

Early identification and treatment of hypertension could lower the risk of cardiovascular diseases; which share the largest proportion of death. The findings of previous studies done in Ethiopia on undiagnosed hypertension were inconsistent. Therefore, this systematic review and meta-analysis aimed to assess the prevalence and associated factors of undiagnosed hypertension among adults in Ethiopia.

Methods

A protocol with registration number CRD42023395445 was registered to Prospective Register of Systematic Reviews (PROSPERO). A comprehensive search of observational studies done on undiagnosed hypertension was identified in PubMed, Google Scholar, Cochrane Library, Hinari databases, and other sources available until January 10, 2023. The quality of the identified studies using the set criteria and necessary data was extracted and exported to R version 4.2.3 and STATA version 15.0 for analysis. The pooled prevalence of undiagnosed hypertension and its associated factors were identified. The risk of bias was evaluated using a funnel plot and Egger's test. The findings were presented using tables, figures, and statements. This study was not funded by any organization.

Results

Eleven studies having 6132 participants were included in the analysis. The pooled prevalence of undiagnosed hypertension was 21% (95% confidence interval [CI]: 16-27). In subanalysis, according to the American Heart Association ( ≥ 130/80 mmHg), the pooled prevalence was 29% (95% CI: 18-40). However, according to the International Society of Hypertension ( ≥ 140/90), the pooled prevalence was 16% (95% CI: 13-20).Sex (AOR = 2.49, 1.48-3.49), age ≥55 years (AOR = 2.68, 1.16-4.21), alcohol drinking (AOR = 2.68, 1.68-3.69), body mass index ≥25 kg/m2 (AOR = 2.62, 1.77-3.48), and high triglyceride levels (AOR = 1.87, 1.22-2.51) were significantly associated with it.

Conclusion

In Ethiopia, about one in five adults ≥ 18 years has undiagnosed hypertension; therefore raising public awareness for medical checkups, early hypertension detection, and treatment is suggested. However, these findings cannot be generalized to pediatrics.

Undiagnosed hypertension and its determinants among hypertensive patients in rural districts of northwest Ethiopia: a mediation analysis

BACKGROUND

Early detection of hypertension is associated with improved blood pressure control and a reduced risk of cardiovascular diseases. However, in rural areas of Ethiopia, evidence is scarce where access to healthcare services is low. This study aimed to estimate the proportion of undiagnosed hypertension and identify its determinants and mediators among patients with hypertension in rural northwest Ethiopia.

METHODS

A community-based cross-sectional study was conducted from September to November 2020. A three-stage sampling technique was used to select a total of 2436 study participants. Blood pressure was measured using an aneroid sphygmomanometer two times, 30 min apart. A validated tool was used to assess participants' beliefs and knowledge of hypertension. The proportion, determinants, and mediators of undiagnosed hypertension were determined among patients with hypertension. The regression-based approach used to calculate the direct and indirect effects of determinants of undiagnosed hypertension. Joint significance testing was used to determine the significance of the indirect effect.

RESULTS

The proportion of undiagnosed hypertension was 84.0% (95% CI: 81.4-86.7%). Participants aged 25-34 years (AOR = 6.03; 95% CI: 2.11, 17.29), who drank alcohol (AOR = 2.40; 95% CI: 1.37, 4.20), were overweight (AOR = 0.41; 95% CI: 0.18, 0.98), had a family history of hypertension (AOR = 0.32; 95% CI: 0.20, 0.53), and had comorbidities (AOR = 0.28; 95% CI: 0.15, 0.54) were significantly associated with undiagnosed hypertension. The mediation analysis revealed that hypertension health information mediated 64.1% and 68.2% of the effect of family history of hypertension and comorbidities on undiagnosed hypertension, respectively. Perceived susceptibility to hypertensive disease mediated 33.3% of the total effect of age on undiagnosed hypertension. Health facility visits also mediated the effect of alcohol drinking (14.2%) and comorbidities (12.3%) on undiagnosed hypertension.

CONCLUSION

A higher proportion of hypertensive patients remain undiagnosed. Being young, drinking alcohol, being overweight, having a family history of hypertension, and having comorbidities were significant factors. Hypertension health information, knowledge of hypertensive symptoms, and perceived susceptibility to hypertension were identified as important mediators. Public health interventions aimed at providing adequate hypertension health information, particularly to young adults and drinkers, could improve knowledge and perceived susceptibility to hypertensive disease and reduce the burden of undiagnosed hypertension.

Does self-medication reduce medical expenditure among the middle-aged and elderly population? A four-wave longitudinal study in China

Introduction

Self-medication has a high prevalence in the middle-aged and elderly population in China. Despite the published evidence demonstrating the economic benefits of self-medication, limited research has addressed the relationship between self-medication and individual medical expenditures, especially within the Chinese population. This study examined the effect of self-medication on individual medical expenditures in China and analyzed the heterogeneity between outpatient and inpatient cases.

Methods

We conducted a panel data analysis using data from four waves of the China Health and Retirement Longitudinal Study (CHARLS). Two-part mixed-effect models were implemented to estimate the effect of self-medication on total outpatient and inpatient expenses and out-of-pocket (OOP) costs, where mixed-effects logit regression was used as the first part, and generalized linear mixed models with log link and gamma distribution was used as the second part.

Results

We identified 72,041 responses representing 24,641 individuals, of which 13,185 responses incurred outpatient expenses and 9,003 responses incurred inpatient costs. Controlling for all covariates, we found that self-medication behaviors were significantly associated with a higher probability of outpatient service utilization (OR = 1.250, 95% CI = 0.179 to 0.269; P < 0.001), but displayed no significant association with outpatient expenses. Respondents who had taken self-medication were less likely to use inpatient services (OR = 0.865, 95% CI = -0.201 to -0.089; P < 0.001), and their inpatient expenses were significantly reduced by 9.4% (P < 0.001). Inpatient OOP costs were significantly reduced by 10.7% (P < 0.001), and outpatient OOP costs were significantly increased by 11.3% (P < 0.001) among respondents who had self-medicated.

Conclusions

This study allowed us to identify the economic value of self-medication among the middle-aged and elderly population in China. Future work should guide the middle-aged and elderly to take responsible self-medication to reduce their economic burden.

Undiagnosed status and associated factors of hypertension among adults living in rural of central, Ethiopia, 2020: Uncovering the hidden magnitude of hypertension

BACKGROUND

Hypertension is a major risk factor for cardiovascular (CVD) disease related deaths worldwide. It affects more than 20% of adults in Ethiopia, making it a major public health concern. Although it is important to uncover the hidden extent of hypertension, there is limited information on the proportion of undiagnosed hypertension in rural areas of the country.

OBJECTIVE

This study aimed to determine the magnitude of undiagnosed hypertension and associated factors among adults living in the rural Dano district, Central Ethiopia 2020.

METHODS AND MATERIALS

A quantitative, community-based cross-sectional study conducted from May to July 2020. A three-stage sampling technique was used to select a total of 605 study participants. A Validated tool was used to assess the participant's behavioral characteristics. Blood pressure was measured using digital blood pressure apparatus. The mean of three blood measurements was used to classify hypertension after intra-class correlation was tested. Standardized instruments were used to assess participants' health-seeking behavior and knowledge of the hypertensive disease. The proportion of undiagnosed hypertension was determined among patients with hypertension. The regression analyses were done to determine factors associated with undiagnosed hypertension. The adjusted odds ratio with 95% CI was estimated to measure the strength of the association. The level of statistical significance was set at a p-value < 0.05.

RESULTS

The prevalence of undiagnosed hypertension was 21.32% (CI: 19.95%, 25.8%). Living in a household with the low wealth index [(AOR: 3.5,95%CI: (1.6,6.4)], far distance to health facility, [(AOR: 0.155,95%CI: (0.11.0.67)], underweight, [AOR = 2.2.1,95%CI:(2.00,4.22)], use of smokeless tobacco products, [AOR = 3.2,95%Cl:(1.88,4.75)], and participants' knowledge of hypertension were independently associated with undiagnosed hypertension.

CONCLUSION

This study shows that undiagnosed hypertension is a major public health problem in the study area. Living in a household with a low wealth index, being far from a health facility, being underweight, using smokeless tobacco products, and having little knowledge about hypertension increase the likelihood of having undiagnosed Hypertension. Hypertension health information, particularly to smokes tobacco users, could improve the perceived susceptibility to hypertensive disease, and reduce the hidden extent of hypertension.

Urban–rural disparities in hypertension prevalence, awareness, treatment, and control among Chinese middle-aged and older adults from 2011 to 2015: a repeated cross-sectional study

Background

China has experienced a continuing increase in hypertension prevalence over the past few decades, especially in rural areas. The paper aims to examine the variation of urban–rural disparities in hypertension prevalence, awareness, treatment, and control among Chinese middle-aged and older adults between 2011 and 2015.

Methods

Our team extracted data from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey of residents aged 45 years and older. In this study, we used the 2011 wave and the 2015 wave of CHARLS. We calculated crude rates and age-adjusted rates of hypertension prevalence, awareness, treatment, and control for the general, urban, and rural populations in each wave and performed chi-square tests to examine urban–rural disparities. We used logistic regression to further confirm these disparities by controlling confounding factors in each wave. We then used generalized estimating equation (GEE) to further examine whether urban–rural disparities changed between 2011 and 2015.

Results

We included 11,129 records in the 2011 wave and 8916 records in the 2015 wave in this study. The mean age was 59.0 years and 5359 (48.2%) participants were male in the 2011 wave. Age-adjusted hypertension prevalence, awareness, treatment, control, and control among treated in the total population were 38.5%, 70.6%, 59.2%, 27.4%, and 46.4% in 2015. Urban–rural disparities in the indicators mentioned above were 5.7%, 13.4%, 15.3%, 9.4% and 5.6% in 2011; which decreased to 4.8%, 2.7%, 5.2%, 4.9% and 3.8% in 2015. Urban–rural disparities in prevalence, awareness and treatment were statistically significant in 2011 but not significant in 2015 adjusted for confounding factors, yet control disparities were statistically significant in both waves. Finally, urban–rural disparities in awareness and treatment had narrowed from 2011 to 2015.

Conclusions

Awareness, treatment, and control rates were sub-optimal among both urban and rural adults. Prevention and management of hypertension among both urban and rural adults should be further strengthened. Awareness and treatment increased more rapidly among rural adults, indicating some achievement had been made in enhancing the healthcare system in rural areas. More efforts are needed in attaining urban–rural equity of healthcare services.

Prevalence of hypertension and possible risk factors of hypertension unawareness among individuals aged 30-75 years from two Panamanian provinces: Results from population-based cross-sectional studies, 2010 and 2019

BACKGROUND

Recent estimates of hypertension in Panama remain unknown. We aim to describe the variation in prevalence and unawareness of hypertension in two Panamanian provinces using two different cross-sectional population-based studies and to investigate risk factors associated with hypertension unawareness.

METHODS

Data were derived from a sub-national study conducted in the provinces of Panama and Colon (PREFREC-2010 [2,733 participants]) and from a nationally representative study (ENSPA-2019), in which we restricted our analyses to the same provinces (4,653 participants). Individuals aged 30-75 years who had (a) self-reported history of hypertension or (b) blood pressure (BP) ≥140/90mmHg or (c) a combination or both were classified as hypertensive. Participants with BP≥140/90mmHg who denied a history of hypertension were considered unaware of the condition. Multivariable logistic regression models were used to estimate the association between risk factors and unawareness, expressed as odds ratios (OR) and 95% confidence interval (CI).

FINDINGS

In 2010, the prevalence and unawareness of hypertension in men were 51.6% (95% CI: 45.7-57.5) and 32.3% (25.4-40.1), respectively, and in women 46.0% (42.1-49.9) and 16.1% (12.6-20.4), respectively. In 2019, the prevalence and unawareness of hypertension in men were 46.5% (42.1-51.0) and 52.3% (45.9-58.6), and in women 42.1% (39.6-44.7) and 33.3% (29.8-37.0). Men (2010 and 2019), age <50 years (2010 and 2019), having no/primary education (2010), and living in a non-urban region (2019) were positively associated with hypertension unawareness, whereas obesity (2010), physical inactivity (2010), family history of hypertension (2019), and BP assessment in the year before study enrollment (2010 and 2019) were inversely associated with hypertension unawareness.

INTERPRETATION

Benefits of a decrease in the prevalence of hypertension are being undermined by an increase in hypertension unawareness. Actions should be encouraged to strengthen the implementation of the existing healthcare program for cardiovascular risk factor control.

Prevalence and associated factors of undiagnosed hypertension among adults in the Central African Republic

The study aimed to estimate the prevalence and associated factors of undiagnosed hypertension (HTN) among adults in the Central African Republic (CAR). In the cross-sectional 2017 CAR (Bangui and Ombella M'Poko) STEPS survey, 3265 persons aged 25 to 64 years (non-pregnant and with complete blood pressure measurement), responded to an interview, biomedical and physical, including blood pressure, measurements. Undiagnosed HTN was classified as systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg among adults who had never been told by a doctor or other health worker that they had raised blood pressure or hypertension and had not been taking antihypertensive medication. Binary logistic regressions are used to estimate factors associated with undiagnosed HTN. Among those with HTN (N = 1373), the proportion of undiagnosed HTN was 69.8% and 30.2% diagnosed HTN. In the adjusted logistic regression analysis, male sex (AOR: 2.12, 95% CI 1.39-3.23), current tobacco use (AOR: 1.58, 95% CI 1.03-2.42), and high physical activity (AOR: 1.93, 95% CI 1.00-3.71) were positively associated, and age (AOR: 0.75, 95% CI 0.59-0.96), and underweight (AOR: 0.58, 95% CI 0.37-0.90) were inversely associated with undiagnosed HTN. In addition, among men, ever screened for glucose (AOR: 0.07, 95% CI 0.02-0.27) was negatively associated with undiagnosed HTN, and among women, married or cohabiting (AOR: 1.20, 95% CI 1.00-1.44), current heavy drinking (AOR: 1.41, 95% CI 1.04-1.91) were positively associated with undiagnosed HTN. Seven in ten of the adult population with HTN had undiagnosed HTN in CAR. Efforts should be reinforced to screen for HTN in the general population.

Burden of undiagnosed hypertension and associated factors among adult populations in Wolaita Sodo Town, Wolaita Zone, Southern Ethiopia

BACKGROUND

Hypertension is defined as two or more measurements of systolic blood pressure equal to or greater than 130 mm Hg or diastolic blood pressure equal to or greater than 80 mm Hg. At the community level, symptoms of hypertension are not often detected in the early stages and it leads to many people being left undiagnosed with the disease. Undiagnosed hypertension increases the risk of complications like heart failure, kidney failure, myocardial infarction, stroke, and premature death. There is a paucity of studies concerning the burden of undiagnosed hypertension in Ethiopia including the study area. Therefore, this study aimed to assess the burden of undiagnosed hypertension among adults in Wolaita Sodo Town, Wolaita Zone, Southern Ethiopia,2021.

METHODS AND MATERIALS

A community-based cross-sectional study involving 662 study participants was conducted at Wolaita Sodo Town from May 3 to July 3, 2021. A systematic random sampling technique was used to select the total number of participants. The data was entered using Epidata version 3, and analyzed by SPSS version 25 respectively. Binary logistic regression was used to check for a possible association. P-values < 0.05 and 95% CI were used on multi-variable analysis as the threshold for the significant statistical association.

RESULTS

A total of 644 have participated in the study giving a response rate of 97.3%. The mean (± SD) age of the study participants was 39.18 (± 10.64) years. This finding showed that the burden of undiagnosed hypertension was 28.8% (95% CI: 24.7-33.2%). Body mass index with overweight (AOR = 2.83, 95% CI: 1.17-6.86), the presence of unrecognized diabetic mellitus (AOR = 1.31 95% CI: 1.11-2.15) habit of alcohol drinking (AOR = 2.91, 95% CI: 1.31-4.48), triglyceride (AOR = 3.48 95% CI: 1.22-9.95), age 31-43 years (AOR = 1.50, 95% CI: 1.02-2.01) were significantly associated factors with undiagnosed hypertension.

CONCLUSIONS

The burden of undiagnosed hypertension findings was high. Body mass index with overweight, unrecognized diabetic mellitus the habit of alcohol drinking, triglyceride, and age 31-43 years were the factors with undiagnosed hypertension. These findings suggested that preventing risk factors and screening for hypertension at the community level should be encouraged for early detection, and monitoring of the burden of hypertension with ages more than 30 years old, high body mass index, and undiagnosed diabetic mellitus in the population.

The Determinants of Undiagnosed Hypertension among Urban Community of Kuala Lumpur, Malaysia

BACKGROUND

The prevalence of undiagnosed hypertension in Malaysia is 17.2%, which is higher compared to the known case of hypertension (13.1%) reported in 2015. For every two people diagnosed with hypertension, there will be three persons with undiagnosed hypertension; the trend has not changed since 2011. This study aimed to determine the determinants of undiagnosed hypertension among urban community of Kuala Lumpur, Malaysia.

METHODS

This was a cross-sectional study conducted among 206 participants in Kuala Lumpur, Malaysia from the ongoing Prospective Urban Rural Epidemiology (PURE) project. The samples with complete variable data were taken from the second year of follow-up, starting Jan 2014 till Dec 2015, through convenience sampling. Data were analyzed using descriptive analysis, simple logistic regression, and multivariable logistic regression.

RESULTS

Multivariable logistic regression showed that only four determinants were associated with undiagnosed hypertension which were the age group of 35 to 49 yr old (aOR: 5.9, 95% CI: 1.8; 19.1), secondary education level (aOR: 2.3, 95% CI: 1.1; 4.6), normal BMI (aOR: 5.1, 95% CI: 1.5; 16.6), and non-diabetes mellitus (aOR: 5.5, 95% CI: 2.5; 12.0).

CONCLUSION

The determinants of undiagnosed hypertension in this study showed that low-risk groups of hypertension were highly underdiagnosed. The low-risk group of hypertension was easily approached at their working place. Thus, routine health screening and awareness campaigns should be emphasized substantially at the working place to detect undiagnosed hypertension. Early detection will be beneficial as early management can be initiated to prevent further complications.

Factors affecting reductions in dietary salt consumption in people of Chinese descent: An integrative review

Aims

To identify and synthesize the evidence on the perceptions of the health effects of dietary salt consumption and barriers to sustaining a salt‐reduced diet for hypertension in Chinese people.

Design

A systematic integrated review integrating quantitative and qualitative studies using the PRISMA guidelines.

Data sources

Three databases, MEDLINE, PubMed and CINAHL, were systematically searched for articles published between January 2001 and July 2020.

Review methods

The quality of the included studies was appraised using the Joanna Briggs Institute's critical appraisal tools for cross‐sectional and qualitative studies. Descriptive analysis and constant comparison methods were used to analyse the extracted data.

Results

Fourteen studies met the inclusion criteria. The synthesized results identified that (i) adequate salt‐related health education had a positive influence on dietary behaviour modifications, (ii) the level of educational exposure to the health benefits of salt reduction influenced Chinese people's perceptions of the health impact associated with high salt intake, (iii) the complexity of salt measurement was a barrier to salt reduction, (iv) salt reduction is a challenge to Chinese food culture, and (v) Chinese migrants may experience linguistic and cultural challenges when they seek appropriate dietary education and advice for hypertension management in their host countries.

Conclusion

There is room for improvement in recognizing and translating the knowledge of salt‐related health issues and the benefits of that knowledge about salt reduction into action. Future nursing interventions should incorporate individuals' cultural needs and the dietary culture of immediate family members.

Impact

This integrative review reveals that unique Chinese customs and practices reduce the effectiveness of salt reduction campaigns. The effects of education vanish without family support, resulting in suboptimal adherence to dietary salt reduction strategies.

The Determinants of Undiagnosed Hypertension Among Indonesian Adults: A Cross-sectional Study Based on the 2014-2015 Indonesia Family Life Survey

Objectives

This study investigated the determinants of undiagnosed hypertension among Indonesian adults.

Methods

This study involved an analysis of secondary data from the 2014 Indonesia Family Life Survey (IFLS) on 5914 Indonesian adults (≥40 years). The determinant variables examined in this cross-sectional study were education level, monthly per capita expenditures (PCE), whether the participant experienced headaches in the morning, and other general health variables. The outcome variable was undiagnosed hypertension, which was defined as participants with hypertension who had not received a hypertension diagnosis from a health professional and had never been prescribed medication for treating hypertension. The data were analyzed using logistic regression.

Results

A total of 3322 participants (56.2%) were found to have undiagnosed hypertension. The odds ratios (ORs) and 95% confidence intervals (CIs) of undiagnosed hypertension were significantly higher among those who completed primary school or lower (OR, 1.60; 95% CI, 1.29 to 1.98), had low monthly PCE (OR, 1.28; 95% CI, 1.13 to 1.43), did not report experiencing headaches in the morning (OR, 1.97; 95% CI, 1.76 to 2.21), and reported a general health status of healthy (OR, 2.05; 95% CI, 1.82 to 2.30) than those who had a higher education level, had high monthly PCE, experienced headaches in the morning, and were unhealthy.

Conclusions

Education level, monthly PCE, the experience of headaches in the morning, and general health status were associated with undiagnosed hypertension. The monitoring system for detecting undiagnosed hypertension cases must be strengthened. Health promotion is also necessary to reduce the prevalence of undiagnosed hypertension.

Association of Daytime Napping with chronic diseases among Tibetan people in China: a cross-sectional study

BACKGROUND

Obesity, diabetes, and hypertension, as three of the most prevalent chronic diseases, remain a daunting health challenge. However, to our knowledge, no study has made a thorough examination of the association between the three chronic diseases and daytime napping, a widely accepted behavior in many countries. This is especially necessary among Tibetan populations, whose lifestyles and health outcomes may be unique, yet patterns of chronic diseases and napping are under-examined. Thus, we sought to explore the aforementioned association in the Tibetan population of China.

METHODS

A total of 2902 participants aged 45-79 in 2019 were included. Multivariate logistic regressions were conducted in 2020. The sex disparity was examined through interaction and stratified analyses.

RESULTS

Hypertension (40.7%) was more prevalent than obesity (20.2%) and diabetes (21.6%). Comparing to non-nappers, those who napped were more likely to have any conditions (OR = 1.30, 95% CI = 1.04-1.62 for 1-59 min/day group and OR = 1.40, 95% CI = 1.10-1.80 for ≥60 min/day group). Participants who had 1-59 min/day of napping were more likely to develop obesity (OR = 1.37, 95% CI = 1.07-1.75), and ≥ 60 min/day of napping was associated with diabetes (OR = 1.33, 95% CI = 1.01-1.74). The interactions between napping and sex were not statistically significant in the models.

CONCLUSIONS

The study revealed napping was unfavorably associated with obesity, diabetes, and any conditions in Tibetan people living on the Tibetan Plateau. Future interventions regarding the three chronic diseases may pay more attention to napping.

TRIAL REGISTRATION

Not applicable.

Prevalence and Factors Associated with Hypertension

Aims: hypertension (HTN) is rapidly emerging as a public health problem among elderly in developing countries. The objective of this study was to assess the prevalence of hypertension and its associated factors among the elderly in Pokhara Metropolitan, Nepal.Methods: a cross-sectional analytical study was carried out to assess hypertension among 323 community dwelling elderly in Pokhara Metropolitan from October 2019 to March 2020. Quota sampling was used to collect the samples. Elderly those who were attending hospitals or with any serious medical conditions were excluded from the study. Face to face interview was done for data collection and anthropometric measurements, and semi structured standard STEPS questionnaires were used as data collection tools. Data were entered in Epi DATA [Version 3.1] and analyzed using SPSS [Version 20] as per data analysis plan. Bivariate logistic regression analysis were conducted and statistical significance was declared at a p-value ≤ 0.05.Results: prevalence of hypertension was reported among 34.4 percent (Male: 39.3%, Female 29%) elderly in Pokhara Metropolitan. The higher proportion of hypertensive cases were in age group 60-69 years (36%). The prevalence of hypertension was significantly associated with ethnicity (OR= 1.74, CI: 1.07-2.83), current alcohol intake (OR= 2.56, CI: 1.30-5.05) and mental stress (OR= 2.25, CI: 1.19-4.28).Conclusion: more than one third of the elderly had hypertension. Ethnicity, current alcohol intake and mental stress are found to be factors associated with hypertension. Periodic screening for early detection of hypertension and implementing health promotion interventions to encourage behavior change among elderly may promote healthy ageing.

Association between daytime napping and obesity in Chinese middle-aged and older adults

Background

No studies have assessed the association between daytime napping and obesity in China. The study aimed to examine the association between daytime napping and obesity among Chinese middle-aged and older adults, and to evaluate the difference between the aforementioned association in men and women.

Methods

Overall, 14 685 participants aged 45 years and older were included by using data from China Health and Retirement Longitudinal Study (CHARLS) in 2015. A multivariable logistic regression model was used to investigate the relationship between daytime napping and obesity after adjusting for potential confounders. Stratified analyses were performed to examine the association differences by sex. Besides, the Cochran-Armitage test for trend was used to detect if there was a significant dose-response relationship between daytime napping and obesity.

Results

The mean age of participants was 60.32, and the mean daytime napping duration was 38.97 minutes. In the sample, compared with no daytime napping group, the risks of being obese were higher in both moderate daytime napping group (1-60 minute/d) (odds ratio OR = 1.27, 95% confidence interval (CI) = 1.13-1.44) and extend long daytime napping group (>60 minute/d) (OR = 1.34, 95% CI = 1.15-1.56). In sex stratification, these significant correlations only existed in women but not in men. Compared with no daytime napping, women who napped 1-60 minute/d and over 60 minute/d were more likely to be obese (OR = 1.37, 95% CI = 1.18-1.59 and OR = 1.49, 95% CI = 1.23-1.81, respectively). Besides, the Cochran-Armitage trend test revealed that the prevalence rate of obesity increased as the daytime napping duration increased (P < 0.001).

Conclusions

The study established the relationship between daytime napping and obesity in a general Chinese population. The association, however, was only detected among women. Furthermore, there was a dose-response relationship between daytime napping and obesity among women. Future studies may verify this association by using a longitudinal design and focus on the mechanisms behind such association.

Burden of Undiagnosed Hypertension among Adults in Urban Communities of Southwest Ethiopia

Background

Hypertension (HTN) is the leading risk factor for mortality due to cardiovascular diseases, it accounts for 7% of global disability adjusted life years. In 2015, it was estimated that around 1.13 billion adults had HTN globally with a high prevalence in low and middle-income countries where the health system is weak to diagnose, treat, and control HTN. Most people with HTN are asymptomatic and go undiagnosed for years. Therefore, the aim of this study was to assess the burden of undiagnosed HTN among adults in urban communities of Southwest Ethiopia.

Methods

A community-based cross-sectional study involving 915 adults from June 17 to July 27, 2019 was performed. WHO STEPS questionnaire was used to collect data, and the collected data were entered using Epi Data version 3.1and analyzed using SPSS version 20, respectively. Binary logistic regression was used to check for a possible association between outcome and independent factors. P-value <0.05 and 95% CI were used on multivariable logistic regression analysis as threshold for significant statistical association.

Results

Undiagnosed HTN in the study area was 21.2% (194). Age (AOR=1.04, 95% CI=1.02–1.05), BMI with overweight (AOR=2.52, 95% CI=1.35–4.71), triglyceride (AOR=1.83, 95% CI=1.29–2.59), and waist to hip ratio (AOR=1.62, 95% CI=1.03–2.54) were factors significantly associated with HTN.

Conclusion

As compared to studies performed before, the risk of undiagnosed HTN in the current study was high. Age, BMI, triglyceride, and waist to hip ratios were found to be the significant factors for it. Preventing the risk factors and screening of HTN should be promoted for early detection, prevention, and treatment of the burden of the disease on the population.

Individual awareness and treatment effectiveness of hypertension among older adults in Ghana: evidence from the World Health Organization study of global ageing and adult health wave 2

INTRODUCTION

the aim of this study was to report the prevalence of hypertension, its awareness and treatment effectiveness among older adults (aged 50 years and above) in Ghana.

METHODS

the Ghana World Health Organization´s (WHO) Study on Global Aging and Adult Health (SAGE) wave 2 dataset was used in this study. The study adopted a cross-sectional study design. Information on self-reported hypertension as well as measured hypertension was analyzed. The level of awareness regarding hypertension and the effectiveness of treatment was determined using descriptive statistics. Factors associated with an individual´s awareness of their hypertensive status were determined using Rao-Scott Chi square test statistic and the predictors of unawareness of hypertension were determined using adjusted logistic regression analysis. A p-value of ≤0.05 was deemed significant.

RESULTS

information on 3,575 adults in Ghana aged 50 years or older was included in this analysis. The mean age of study participants was 65.1 ± 10.7 years with 59% being female. The prevalence of measured hypertension was 50.7% [95%CI=48.3-53.2]. The overall prevalence of hypertension among older adults in Ghana who were hypertensive but were not aware of it was 35.0% [95%CI=31.6-38.5]. Of the 332 individuals who self-reported being hypertensive, only 74 (22.2%) were on any form of treatment, with only 17 (5.1%) having their blood pressures well controlled.

CONCLUSION

approximately half of all older adults in Ghana have elevated blood pressures. Most of these are not aware of their elevated blood pressure and for those who are aware, very few are on treatment and even fewer have their blood pressure well controlled. Structured national population level screening and health promotion for elevated blood pressure by Ministry of Health/ Ghana Health Service is worthy of consideration.

Prevalence and Associated Factors of Compliance Behaviors among Middle-Aged and Older Hypertensive Patients in China: Results from the China Health and Retirement Longitudinal Study

Partial or total non-adherence has been recognized as major issues in the long-term management of hypertension. This study aims to investigate the prevalence and associated factors of compliance behaviors among Chinese middle-aged and older hypertensive patients. A sample of 6308 hypertensive patients aged ≥45 years was obtained from the 2015 China Health and Retirement Longitudinal Study (CHARLS) data. Two compliance behaviors were involved including medication and blood pressure monitoring. Stratified binary logistic regression analysis was employed to examine the associated factors. 77.2% of the participants reported medication compliance, and 40.7% complied with blood pressure monitoring. Better medication compliance associated with older age, overweight or obesity, one or ≥3 complications, no drinking, living in urban areas, and health education. Better blood pressure monitoring compliance associated with older age, overweight or obesity, ≥3 complications, normal activities of daily living (ADL), no smoking, sleep duration of 6-8 h, better cognitive function, living in urban areas, education level of middle school or above, and health education. Chinese middle-aged and older hypertensive patients experienced unoptimistic compliance behaviors, especially for blood pressure monitoring. Special attention and targeted interventions are urgent for the high-risk population of poor compliance behaviors, such as rural individuals, low educational population, and younger hypertensive patients.

Examining the prevalence, correlates and inequalities of undiagnosed hypertension in Nepal: a population-based cross-sectional study

OBJECTIVE

To examine the prevalence, correlates and sociodemographic inequalities of undiagnosed hypertension in Nepal.

DESIGN

This study used cross-sectional 2016 Nepal Demographic and Health Survey (NDHS) data. Undiagnosed patients with hypertension were defined as an NDHS respondent who was diagnosed as hypertensive (systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg) during the survey, but never took any prescribed anti-hypertensive medicine to lower/control blood pressure and was never identified as having hypertension by a health professional prior the survey. Multiple binary logistic regression analysis was performed, and Concentration Index was measured.

SETTING

Nepal.

PARTICIPANTS

Adult patients with hypertension.

RESULTS

Among 3334 patients with hypertension, 50.4% remained undiagnosed during the survey in Nepal. Adjusted model reveals that patients who were male, belonged to households other than the highest wealth quintile, and lived in province 4 and province 5 were at higher risk of remaining undiagnosed for hypertension. Patients who were ≥65 years of age and were overweight/obese were at lower risk of remaining undiagnosed for hypertension. The poor-rich gap was 24.6 percentage points (Q1=64.1% vs Q5=39.6%) and poor:rich ratio was 1.6 (Q1/Q5=1.6) in the prevalence of undiagnosed hypertension. Undiagnosed hypertension was disproportionately higher among lower socioeconomic status groups (Concentration Index, C=-0.18). Inequalities in the prevalence of undiagnosed hypertension further varied across other geographic locations, including place of residence, ecological zones and administrative provinces.

CONCLUSIONS

Undiagnosed hypertension was highly prevalent in Nepal and there were substantial inequalities by sociodemographics and subnational levels. Increasing awareness, strengthening routine screening to diagnose hypertension at primary health service facilities and enactment of social health insurance policy may help Nepal to prevent and control this burden.