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      Association of socioeconomic status with diagnosis, treatment and control of hypertension in diabetic hypertensive individuals in Bangladesh: a population-based cross-sectional study

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          Abstract

          Objectives

          This study aimed to examine if socioeconomic status could affect the likelihood of diagnosis, treatment and control of hypertension in diabetic hypertensive individuals.

          Design

          Cross-sectional nationally representative study.

          Settings

          Bangladesh.

          Participants

          This paper used data from the 2011 Bangladesh Demographic Health Survey. The analyses were based on the responses of 339 diabetes hypertensive individuals.

          Main outcome measures

          Diagnosis, treatment and control of hypertension.

          Results

          The age-adjusted prevalence of hypertension in diabetes individuals was 38.4% in the study population. Among diabetic hypertensive subjects only 65.7% had been diagnosed, 58.4% were receiving treatment and 42% controlled their hypertension. Individuals from high socioeconomic status (AOR 2.60; 95% CI 1.16–5.83) had an increased likelihood of reporting diagnosis of hypertension. Individuals from medium (AOR 2.22; 95% CI 1.11–4.46) and high socioeconomic status (AOR 3.47; 95% CI 1.59–7.58) had increased chance of receiving treatment. In addition, individuals belonging to high socioeconomic status (AOR 2.53; 95% CI 1.14–5.63) were more likely to report of controlling hypertension.

          Conclusions

          This study indicated that hypertension is more prevalent among diabetic patients. Furthermore, diabetic hypertensive patients from the low socioeconomic status group are also less likely to be diagnosed and also less likely to receive treatment for hypertension. In addition, diabetic hypertensive patients from the low socioeconomic status were less likely to control hypertension compared with an individual belonging to the high socioeconomic status group. This reduced likelihood of receiving proper treatment will lead to a rapid increase in the prevalence of macrovascular and microvascular diseases among diabetic hypertensive patients.

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          Most cited references19

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          Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study.

          To determine the relation between systolic blood pressure over time and the risk of macrovascular or microvascular complications in patients with type 2 diabetes. Prospective observational study. 23 hospital based clinics in England, Scotland, and Northern Ireland. 4801 white, Asian Indian, and Afro-Caribbean UKPDS patients, whether randomised or not to treatment, were included in analyses of incidence; of these, 3642 were included in analyses of relative risk. Primary predefined aggregate clinical outcomes: any complications or deaths related to diabetes and all cause mortality. Secondary aggregate outcomes: myocardial infarction, stroke, lower extremity amputation (including death from peripheral vascular disease), and microvascular disease (predominantly retinal photocoagulation). Single end points: non-fatal heart failure and cataract extraction. Risk reduction associated with a 10 mm Hg decrease in updated mean systolic blood pressure adjusted for specific confounders. The incidence of clinical complications was significantly associated with systolic blood pressure, except for cataract extraction. Each 10 mm Hg decrease in updated mean systolic blood pressure was associated with reductions in risk of 12% for any complication related to diabetes (95% confidence interval 10% to 14%, P<0.0001), 15% for deaths related to diabetes (12% to 18%, P<0.0001), 11% for myocardial infarction (7% to 14%, P<0.0001), and 13% for microvascular complications (10% to 16%, P<0.0001). No threshold of risk was observed for any end point. In patients with type 2 diabetes the risk of diabetic complications was strongly associated with raised blood pressure. Any reduction in blood pressure is likely to reduce the risk of complications, with the lowest risk being in those with systolic blood pressure less than 120 mm Hg.
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            Diabetes, Hypertension, and Cardiovascular Disease

            Hypertension, 37(4), 1053-1059
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              Measuring the magnitude of socio-economic inequalities in health: an overview of available measures illustrated with two examples from Europe.

              In this paper we review the available summary measures for the magnitude of socio-economic inequalities in health. Measures which have been used differ in a number of important respects, including (1) the measurement of "relative" or "absolute" differences; (2) the measurement of an "effect" of lower socio-economic status, or of the "total impact" of socio-economic inequalities in health upon the health status of the population; (3) simple versus sophisticated measurement techniques. Based on this analysis of summary measures which have previously been applied, eight different classes of summary measures can be distinguished. Because measures of "total impact" can be further subdivided on the basis of their underlying assumptions, we finally arrive at 12 types of summary measure. Each of these has its merits, and choice of a particular type of summary measure will depend partly on technical considerations, partly on one's perspective on socio-economic inequalities in health. In practice, it will often be useful to compare the results of several summary measures. These principles are illustrated with two examples: one on trends in the magnitude of inequalities in mortality by occupational class in Finland, and one on trends in the magnitude of inequalities in self-reported morbidity by level of education in the Netherlands.
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                Author and article information

                Journal
                JRSM Open
                JRSM Open
                SHR
                spshr
                JRSM Open
                SAGE Publications (Sage UK: London, England )
                2054-2704
                8 October 2015
                October 2015
                : 6
                : 10
                : 2054270415608118
                Affiliations
                [1 ]Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi 6205, Bangladesh
                [2 ]UChicago Research Bangladesh, House 4, Road 2/B, Sector 4, Uttra-1230, Dhaka, Bangladesh
                [3 ]Ministry of Health and Family Welfare, Bangladesh Secretariat, Dhaka 1000, Bangladesh
                [4 ]Department of Medical Biology and Genetics, Gaziantep University, Turkey
                Author notes
                [*]Mosiur Rahman. Email: swaponru_2000@ 123456yahoo.com
                Article
                10.1177_2054270415608118
                10.1177/2054270415608118
                4601127
                26688743
                edff047e-8677-4edd-b68e-d892c35ce8fe
                © The Author(s) 2015

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License ( http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page( https://us.sagepub.com/en-us/nam/open-access-at-sage).

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                Research

                diabetes,hypertension,diagnosis,treatment,control,ses,bangladesh
                diabetes, hypertension, diagnosis, treatment, control, ses, bangladesh

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