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Urban-rural disparities in hypertension prevalence, detection, and medication use among Chinese Adults from 1993 to 2011

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      Abstract

      BackgroundChina has experienced a rapid increase in hypertension over the past decade, especially in rural. Therefore, the aim of this research is to examine the dynamic trends in urban-rural disparities in hypertension prevalence, detection, and medication use among Chinese adults from 1993 to 2011.MethodsData were extracted from the seven latest waves of the China Health and Nutrition Survey (CHNS). We used the hukou system to distinguish between urban and rural residents. Chi-square tests were performed to examine urban-rural gaps in hypertension prevalence, detection and medication use. Multiple logistic regressions were used to confirm these disparities and to explore whether the urban-rural gaps have narrowed or widened from 1993 to 2011, after controlling for health-related behaviors, BMI, demographic variables and socioeconomic characteristics. Blinder-Oaxaca decomposition technique was also used to calculate the extent to which urban-rural disparities reflect an endowments effect or a coefficients effect.ResultsHypertension prevalence, detection, and medication use among rural adults were significantly lower than urban adults, with the significant level at p < 0.001. The urban-rural gaps in hypertension prevalence and medication use gradually narrowed during the period 1993–2011, whereas the gaps in hypertension detection grew wider. After controlling for confounding variables, urban adults were about 24.5, 49.4, and 89.5% more likely to be hypertensive, detected, and medicated than their rural counterparts (p < 0.01), respectively. The Blinder-Oaxaca decomposition suggested that approximately 22 and 26% of the urban-rural gap in hypertension detection and medication use could be attributed to coefficient difference, respectively.ConclusionsAlthough hypertension prevalence among rural adults was comparable to that of urban adults, hypertension detection and medication use of rural adults were still suboptimal. Unusually large urban-rural gaps and an expanding trend in hypertension detection deserve the attention of health policymakers and researchers.

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      Most cited references 35

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      The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.

      "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" provides a new guideline for hypertension prevention and management. The following are the key messages(1) In persons older than 50 years, systolic blood pressure (BP) of more than 140 mm Hg is a much more important cardiovascular disease (CVD) risk factor than diastolic BP; (2) The risk of CVD, beginning at 115/75 mm Hg, doubles with each increment of 20/10 mm Hg; individuals who are normotensive at 55 years of age have a 90% lifetime risk for developing hypertension; (3) Individuals with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80 to 89 mm Hg should be considered as prehypertensive and require health-promoting lifestyle modifications to prevent CVD; (4) Thiazide-type diuretics should be used in drug treatment for most patients with uncomplicated hypertension, either alone or combined with drugs from other classes. Certain high-risk conditions are compelling indications for the initial use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); (5) Most patients with hypertension will require 2 or more antihypertensive medications to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg for patients with diabetes or chronic kidney disease); (6) If BP is more than 20/10 mm Hg above goal BP, consideration should be given to initiating therapy with 2 agents, 1 of which usually should be a thiazide-type diuretic; and (7) The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated. Motivation improves when patients have positive experiences with and trust in the clinician. Empathy builds trust and is a potent motivator. Finally, in presenting these guidelines, the committee recognizes that the responsible physician's judgment remains paramount.
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        Wage Discrimination: Reduced Form and Structural Estimates

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          Global burden of hypertension: analysis of worldwide data

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            Author and article information

            Affiliations
            [1 ]ISNI 0000 0004 1761 1174, GRID grid.27255.37, , Shandong University, ; Jinan, People’s Republic of China
            [2 ]ISNI 0000 0001 2171 9311, GRID grid.21107.35, , Johns Hopkins Bloomberg School of Public Health, ; Baltimore, USA
            [3 ]ISNI 0000 0004 1761 1174, GRID grid.27255.37, , Infirmary of Shandong University, ; Jinan, People’s Republic of China
            [4 ]GRID grid.452704.0, , The Second Hospital of Shandong University, ; Jinan, People’s Republic of China
            Contributors
            ORCID: http://orcid.org/0000-0001-7458-7682, lijiajia@sdu.edu.cn
            lshi@jhsph.edu
            shixueli@sdu.edu.cn
            lzxu@sdu.edu.cn
            qinwen@sdu.edu.cn
            09wangheng@tongji.edu.cn
            Journal
            Int J Equity Health
            Int J Equity Health
            International Journal for Equity in Health
            BioMed Central (London )
            1475-9276
            14 March 2017
            14 March 2017
            2017
            : 16
            28288635
            5348878
            545
            10.1186/s12939-017-0545-7
            © The Author(s). 2017

            Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

            Funding
            Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
            Award ID: 71303137
            Award ID: 71673170
            Award Recipient :
            Funded by: Youth Talents Innovation Foundation of School of Public Health Shandong University
            Award ID: N/A
            Award Recipient :
            Categories
            Research
            Custom metadata
            © The Author(s) 2017

            Health & Social care

            urban/rural, hukou system, hypertension, dynamic trends, china

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