J Korean Med Sci.  2017 Apr;32(4):561-567. 10.3346/jkms.2017.32.4.561.

Socioeconomic Disparities in the Prevalence, Diagnosis, and Control of Hypertension in the Context of a Universal Health Insurance System

• Lee HY

• KMID: 2371438
• DOI: http://doi.org/10.3346/jkms.2017.32.4.561

Abstract

A lower use of preventive intervention in low socioeconomic populations has been described in countries with universal coverage health care systems, but little is known about the possible socioeconomic inequalities in secondary prevention in a universal health insurance system. Data from the 2010-2013 Korea National Health and Nutrition Examination Survey, a nationwide survey, were analyzed. A total of 20,044 subjects older than 30 years of age were included after excluding subjects with missing data. Prevalence ratios were calculated using Poisson regression models with robust variance to explore factors associated with the prevalence, unawareness, and inappropriate control of hypertension. Hypertension prevalence decreased with increasing education and income level. We observed an inverse association between education level and undiagnosed hypertension among women, but not men. Socioeconomic level was not associated with inadequate control of hypertension among men or women. Future interventions should include primary prevention efforts targeted at lower socioeconomic populations to reduce disparities. There is substantial room for improvement in secondary prevention efforts. Monitoring strategies may highlight gaps in the preventive and care services offered to the most vulnerable individuals and encourage governments and practitioners to address these gaps.

Keyword

Hypertension; Prevalence; Awareness; Control; Universal Coverage

Reference

1. Wu Y, Tai ES, Heng D, Tan CE, Low LP, Lee J. Risk factors associated with hypertension awareness, treatment, and control in a multi-ethnic Asian population. J Hypertens. 2009; 27:190–197.

2. Ikeda N, Sapienza D, Guerrero R, Aekplakorn W, Naghavi M, Mokdad AH, Lozano R, Murray CJ, Lim SS. Control of hypertension with medication: a comparative analysis of national surveys in 20 countries. Bull World Health Organ. 2014; 92:10–19C.

3. Chow CK, Teo KK, Rangarajan S, Islam S, Gupta R, Avezum A, Bahonar A, Chifamba J, Dagenais G, Diaz R, et al. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA. 2013; 310:959–968.

4. Wolf-Maier K, Cooper RS, Kramer H, Banegas JR, Giampaoli S, Joffres MR, Poulter N, Primatesta P, Stegmayr B, Thamm M. Hypertension treatment and control in five European countries, Canada, and the United States. Hypertension. 2004; 43:10–17.

5. Damasceno A, Azevedo A, Silva-Matos C, Prista A, Diogo D, Lunet N. Hypertension prevalence, awareness, treatment, and control in mozambique: urban/rural gap during epidemiological transition. Hypertension. 2009; 54:77–83.

6. Alkerwi A, Pagny S, Lair ML, Delagardelle C, Beissel J. Level of unawareness and management of diabetes, hypertension, and dyslipidemia among adults in Luxembourg: findings from ORISCAV-LUX Study. PLoS One. 2013; 8:e57920.

7. Munoz MA, Rohlfs I, Masuet S, Rebato C, Cabañero M, Marrugat J; ICAR Study Group. Analysis of inequalities in secondary prevention of coronary heart disease in a universal coverage health care system. Eur J Public Health. 2006; 16:361–367.

8. Yoon SS, Gu Q, Nwankwo T, Wright JD, Hong Y, Burt V. Trends in blood pressure among adults with hypertension: United States, 2003 to 2012. Hypertension. 2015; 65:54–61.

9. Ministry of Health and Welfare. Korea Centers for Disease Control and Prevention. Korea Health Statistics 2012: Korea National Health and Nutrition Examination Survey (KNHANES V-3). Cheongwon: Korea Centers for Disease Control and Prevention;2013.

10. Espelt A, Kunst AE, Palència L, Gnavi R, Borrell C. Twenty years of socio-economic inequalities in type 2 diabetes mellitus prevalence in Spain, 1987–2006. Eur J Public Health. 2012; 22:765–771.

11. Deddens JA, Petersen MR. Approaches for estimating prevalence ratios. Occup Environ Med. 2008; 65:501–506.

12. Barros AJ, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol. 2003; 3:21.

13. Spiegelman D, Hertzmark E. Easy SAS calculations for risk or prevalence ratios and differences. Am J Epidemiol. 2005; 162:199–200.

14. Guo F, He D, Zhang W, Walton RG. Trends in prevalence, awareness, management, and control of hypertension among United States adults, 1999 to 2010. J Am Coll Cardiol. 2012; 60:599–606.

15. Falaschetti E, Mindell J, Knott C, Poulter N. Hypertension management in England: a serial cross-sectional study from 1994 to 2011. Lancet. 2014; 383:1912–1919.

16. Lee Y, Lee SG, Lee MH, Kim JH, Lee BW, Kang ES, Lee HC, Cha BS. Serum cholesterol concentration and prevalence, awareness, treatment, and control of high low-density lipoprotein cholesterol in the Korea National Health and Nutrition Examination Surveys 2008–2010: beyond the tip of the iceberg. J Am Heart Assoc. 2014; 3:e000650.

17. Danaei G, Finucane MM, Lin JK, Singh GM, Paciorek CJ, Cowan MJ, Farzadfar F, Stevens GA, Lim SS, Riley LM, et al. National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5·4 million participants. Lancet. 2011; 377:568–577.

18. Maimaris W, Paty J, Perel P, Legido-Quigley H, Balabanova D, Nieuwlaat R, McKee M. The influence of health systems on hypertension awareness, treatment, and control: a systematic literature review. PLoS Med. 2013; 10:e1001490.

19. Chu SH, Baek JW, Kim ES, Stefani KM, Lee WJ, Park YR, Youm Y, Kim HC. Gender differences in hypertension control among older Korean adults: Korean social life, health, and aging project. J Prev Med Public Health. 2015; 48:38–47.

20. Choi KM, Park HS, Han JH, Lee JS, Lee J, Ryu OH, Lee KW, Cho KH, Yoon D, Baik SH, et al. Prevalence of prehypertension and hypertension in a Korean population: Korean National Health and Nutrition Survey 2001. J Hypertens. 2006; 24:1515–1521.

21. Shin J, Park JB, Kim KI, Kim JH, Yang DH, Pyun WB, Kim YG, Kim GH, Chae SC; Guideline Committee of the Korean Society of Hypertension. 2013 Korean Society of Hypertension guidelines for the management of hypertension: part I–epidemiology and diagnosis of hypertension. Clin Hypertens. 2015; 21:1.

22. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005; 365:217–223.

23. Lee HY, Hahm MI, Choi KS, Jun JK, Suh M, Nam CM, Park EC. Different socioeconomic inequalities exist in terms of the prevention, diagnosis and control of diabetes. Eur J Public Health. 2015; 25:961–965.

24. Estoppey D, Paccaud F, Vollenweider P, Marques-Vidal P. Trends in self-reported prevalence and management of hypertension, hypercholesterolemia and diabetes in Swiss adults, 1997–2007. BMC Public Health. 2011; 11:114.

25. Cheung BM, Cheung TT. Challenges in the management of hypertension in Asia. Eur Heart J Suppl. 2012; 14:A37–A38.

26. Wozniak G, Khan T, Gillespie C, Sifuentes L, Hasan O, Ritchey M, Kmetik K, Wynia M. Hypertension control cascade: a framework to improve hypertension awareness, treatment, and control. J Clin Hypertens (Greenwich). 2016; 18:232–239.

27. Moon JY, Park KJ, Hwangbo Y, Lee MR, Yoo BI, Won JH, Park YH. A trend analysis of the prevalence, awareness, treatment, and control of hypertension by age group. J Prev Med Public Health. 2013; 46:353–359.

28. Agyemang C, van Valkengoed I, Hosper K, Nicolaou M, van den Born BJ, Stronks K. Educational inequalities in metabolic syndrome vary by ethnic group: Evidence from the SUNSET study. Int J Cardiol. 2010; 141:266–274.

29. Vernay M, Salanave B, de Peretti C, Druet C, Malon A, Deschamps V, Hercberg S, Castetbon K. Metabolic syndrome and socioeconomic status in France: the French nutrition and health survey (ENNS, 2006–2007). Int J Public Health. 2013; 58:855–864.

30. Agardh E, Allebeck P, Hallqvist J, Moradi T, Sidorchuk A. Type 2 diabetes incidence and socio-economic position: a systematic review and meta-analysis. Int J Epidemiol. 2011; 40:804–818.

31. Espelt A, Borrell C, Roskam AJ, Rodríguez-Sanz M, Stirbu I, Dalmau-Bueno A, Regidor E, Bopp M, Martikainen P, Leinsalu M, et al. Socioeconomic inequalities in diabetes mellitus across Europe at the beginning of the 21st century. Diabetologia. 2008; 51:1971–1979.

32. Gakidou E, Mallinger L, Abbott-Klafter J, Guerrero R, Villalpando S, Ridaura RL, Aekplakorn W, Naghavi M, Lim S, Lozano R, et al. Management of diabetes and associated cardiovascular risk factors in seven countries: a comparison of data from national health examination surveys. Bull World Health Organ. 2011; 89:172–183.

33. Do YK, Eggleston KN. Educational disparities in quality of diabetes care in a universal health insurance system: evidence from the 2005 Korea National Health and Nutrition Examination Survey. Int J Qual Health Care. 2011; 23:397–404.

34. Kautzky-Willer A, Dorner T, Jensby A, Rieder A. Women show a closer association between educational level and hypertension or diabetes mellitus than males: a secondary analysis from the Austrian HIS. BMC Public Health. 2012; 12:392.

35. Nolte E, Bain C, McKee M. Diabetes as a tracer condition in international benchmarking of health systems. Diabetes Care. 2006; 29:1007–1011.

36. Dasgupta K, Khan S, Ross NA. Type 2 diabetes in Canada: concentration of risk among most disadvantaged men but inverse social gradient across groups in women. Diabetic MedicineDiabet Med. 2010; 27:522–531.

37. Naing C, Yeoh PN, Wai VN, Win NN, Kuan LP, Aung K. Hypertension in Malaysia: an analysis of trends from the National Surveys 1996 to 2011. Medicine (Baltimore). 2016; 95:e2417.

38. Cramm JM, Nieboer AP. Short and long term improvements in quality of chronic care delivery predict program sustainability. Soc Sci Med. 2013; 101:148–154.