Inequalities and risk factors analysis in prevalence and management of hypertension in India and Nepal: a national and subnational study

Rauniyar, Santosh Kumar; Rahman, Md. Mizanur; Rahman, Md. Shafiur; Abe, Sarah Krull; Nomura, Shuhei; Shibuya, Kenji

doi:10.1186/s12889-020-09450-6

Cited by 18 publications

(19 citation statements)

References 42 publications

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“…However, contrastingly, in our study, the uncontrolled or under-treated hypertension was found to be higher in the urban areas by 7.2 percentage points. Our study corroborates with the findings of previous studies that wealth and education are important determinants in both control and treatment of hypertension [50]. Studies have found that sedentary lifestyle and unhealthy eating habits are higher in urban areas leading to obesity and eventually results in uncontrolled hypertension despite treatment [51,52].…”

Section: Discussionsupporting

confidence: 92%

Decomposing the rural–urban gap in the prevalence of undiagnosed, untreated and under-treated hypertension among older adults in India

Boro

Banerjee

2022

BMC Public Health

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Background Although awareness and treatment rates of hypertension have significantly improved in recent years, the prevalence of undiagnosed and untreated hypertension remains a major public health concern for Indian policymakers. While the urban–rural variation in the prevalence, diagnosis, control, and treatment of hypertension is reasonably well-documented, the explanation behind such variation remains poorly understood given the dearth of studies conducted on exploring the determinants of the rural–urban gap in the prevalence of undiagnosed, untreated, and uncontrolled hypertension in India. In view of this research gap, our paper aims to decompose the inter-group differences between rural and urban areas in undiagnosed, untreated, and undertreated hypertension among older adults in India into the major contributing factors. Methods Nationally representative data collected in the Longitudinal Ageing Study of India, Wave-1 (2017–18), was utilized for this study. Maximum-likelihood binary logistic-regression models were employed to capture the crude and adjusted associations between the place of residence and prevalence of undiagnosed, untreated, and undertreated hypertension. Fairlie’s decomposition technique was used to decompose the inter-group differences between rural and urban residents in the prevalence of undiagnosed, untreated, and undertreated hypertension among the older population in India, into the major contributing factors, in order to explore the pathways through which these differences manifest. Results The overall prevalence rates of undiagnosed, untreated, and undertreated hypertension among older adults were 42.3%, 6%, and 18.7%, respectively. However, the prevalence of undiagnosed and untreated hypertension was higher in rural areas, by 12.4 and 1.7 percentage-points, respectively, while undertreated hypertension was more prevalent in the urban areas (by 7.2 percentage-points). The decomposition analysis explained roughly 41% and 34% of the urban advantage over rural areas in the case of undiagnosed and untreated hypertension, while it explained 51% of the urban disadvantage in respect of undertreated hypertension. The rural–urban differentials in education and comorbidities accounted for the majority of the explained rural disadvantage in the prevalence of undiagnosed hypertension, explaining 13.51% and 13.27% of the gap, respectively. The regional factor was found to be the major driver behind urban advantage in the prevalence of untreated hypertension, contributing 37.47% to the overall gap. In the case of undertreated hypertension, education, comorbidities, and tobacco consumption were the major contributors to the urban–rural inequality, which accounted for 12.3%, 10.6%, and 9.8% of the gap, respectively. Conclusion Socio-economic and lifestyle factors seemed to contribute significantly to the urban–rural gap in undiagnosed, untreated and undertreated hypertension in India among older adults. There is an urgent need of creating awareness programmes for the early identification of hypertensive cases and regular treatment, particularly in under-serviced rural India. Interventions should be made targeting specific population groups to tackle inequality in healthcare utilization.

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Section: Discussionsupporting

confidence: 92%

Decomposing the rural–urban gap in the prevalence of undiagnosed, untreated and under-treated hypertension among older adults in India

Boro

Banerjee

2022

BMC Public Health

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“…6 Sabapathy et al included school-children of Bangalore, south India, in their study and found that prevalence of prehypertension and hypertension was 2.7% and 3.2%, respectively. 7 Compared with this, overall prevalence of hypertension among adults in India was 11.4% (95% confidence interval [CI], 11.4-11.5) as shown by Rauniyar et al 8 Our study aims to determine the prevalence of prehypertension and hypertension in the community levels of India in the eastern parts, which has not been documented on a large scale, and identify its contributing factors, which would establish an early prevention program in the long run.…”

Section: Introductionmentioning

confidence: 76%

A Study on Burden of Prehypertension in Youth (or Pediatric Hypertension) in West Bengal, India

RoyChoudhury

Nayek

Saha

2021

Journal of Child Science

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Hypertension is a silent threat to the developing countries in recent times. The aim of this article was to determine the burden of prehypertension and hypertension among school-going children and the risk factors associated with those conditions. A cross-sectional study was conducted among school-going children (6–18 years) in seven schools of Burdwan, West Bengal, India, selected by stratified random sampling from March 2017 to August 2018. Anthropometric and blood pressure measurements were obtained along with sociodemographic parameters. Prehypertension and hypertension were defined as per American Pediatric Society's definition. Mean age of the study population was 11.3 ± 3.8 years (n = 604). Prevalence of prehypertension and hypertension was estimated to be 5% and 4.6%, respectively. Both prehypertension and hypertension were more common among children aged > 15 years (10.3% and 15.5%). In logistic regression, the independent determinants of hypertension were higher socioeconomic condition, increasing age, obesity, increased intake of junk food, parental hypertension, and obesity among first-degree relatives. Proper preventive measures are the need of the hour to tackle the emerging epidemic at its root. Periodic measurements of blood pressure at regular intervals are advisable at community levels to recognize high-risk children, control obesity, and prevent irreversible end organ damages.

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“…Previous studies examining the prevalence of NCDs using nationally representative datasets such as the Nepal Demographic and Health Survey 2016 (NDHS) have identified high burden PLOS GLOBAL PUBLIC HEALTH of hypertension in Nepal [13,21]. However, NHDS does not disclose the specific population groups and their sample sizes, which makes it difficult to determine the prevalence of NCDs in a particular population group within Nepal.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and determinants of hypertension in underrepresented indigenous populations of Nepal

Denekew

Gautam

Bhandari

et al. 2022

PLOS Glob Public Health

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Indigenous populations residing in low- and middle-income countries (LMICs) are highly underrepresented in medicine and public health research. Specifically, data on non-communicable diseases (NCDs) from indigenous populations remains scarce. Despite the increasing burden of NCDs in the Himalayan region, their prevalence in many indigenous populations remains understudied. The nationally representative public health surveys often do not include the indigenous communities, especially those that reside in rural areas or exist in small numbers. This observational cross-sectional survey study aimed to assess the prevalence of three NCD risk factors namely obesity, hypertension, and tachycardia and identify dietary and lifestyle variables associated with them across underrepresented indigenous populations of Nepal. A total of 311 individuals (53.3% women, 46.7% men) with mean age 43±15 years from 12 indigenous Nepali communities residing in rural (47.9%) or semi-urban (52.1%) areas volunteered to participate in this study. Univariate tests and multivariable logistic regressions were used to analyze the survey data. The mean systolic and diastolic blood pressures were 121.3±19.5 mmHg and 81.3±11.8 mmHg respectively. Overall, the prevalence of obesity and tachycardia was low (0.64% and 3.22%, respectively) but hypertension was prevalent at 23.8%. Hypertension was not significantly different across populations, but it was associated with age, BMI, and tobacco use, and collectively, these variables explained 13.9% variation in hypertension prevalence. Although we were unable to detect direct associations between individual determinants of hypertension identified in non-indigenous Nepalis, such as education levels, alcohol consumption, and smoking in this study, having one or more determinants increased the odds of hypertension in the indigenous participants. Furthermore, ~14% of the hypertensive individuals had none of the universally identified hypertension risk factors. The lack of association between previously identified risk factors for hypertension in these individuals indicates that the additional determinants of hypertension remain to be identified in indigenous Nepali populations.

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Inequalities and risk factors analysis in prevalence and management of hypertension in India and Nepal: a national and subnational study

Cited by 18 publications

References 42 publications

Decomposing the rural–urban gap in the prevalence of undiagnosed, untreated and under-treated hypertension among older adults in India

Decomposing the rural–urban gap in the prevalence of undiagnosed, untreated and under-treated hypertension among older adults in India

A Study on Burden of Prehypertension in Youth (or Pediatric Hypertension) in West Bengal, India

Prevalence and determinants of hypertension in underrepresented indigenous populations of Nepal

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