家庭筛查和健康信息的提供能否改善高血压的诊断、治疗和控制?印度城市的回归不连续分析

Michaela Theilmann, Sneha Sarah Mani, Pascal Geldsetzer, Shivani A. Patel, Mohammed K. Ali, Harsha Thirumurthy, KM Venkat Narayan, Viswanathan Mohan, Dorairaj Prabhakaran, Nikhil Tandon, Nikkil Sudharsanan
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引用次数: 0

摘要

背景:在印度,一些邦政府正在实施或考虑实施家庭高血压筛查计划,以提高全民诊断率和血压(BP)控制率。然而,有关印度家庭高血压筛查项目有效性的证据有限:方法:我们利用六波具有人口代表性的队列数据(N = 15,573),采用回归不连续设计的新方法,估算了家庭高血压筛查干预对诊断、治疗和血压的因果效应。研究结果:我们发现,在家中筛查个人血压并为血压升高者提供健康信息和转介服务并不能有效改善高血压诊断(0.1,P 值:0.82)、治疗(-0.2,P 值:0.49)或血压水平(收缩压:-1.8,P 值:0.03;舒张压:0.5,P 值:0.39)。这种无效效应在不同的亚人群和替代规格中都是稳健的。解释:我们的研究结果表明,不了解自己的高血压状况可能不是印度诊断率和治疗率低的主要原因,其他结构性和行为性障碍可能与此相关。要将印度的筛查工作转化为改善人口健康的成果,就必须调整筛查工作以解决这些额外的障碍。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Does home-based screening and health information provision improve hypertension diagnosis, treatment, and control? A regression discontinuity analysis in urban India
Background: In India, several state governments are implementing or considering home-based hypertension screening programs to improve population-wide diagnosis and blood pressure (BP) control rates. However, there is limited evidence on the effectiveness of home-based screening programs in India. Methods: Using six waves of population-representative cohort data (N = 15,573), we estimate the causal effect of a home-based hypertension screening intervention on diagnosis, treatment, and BP using a novel application of the Regression Discontinuity Design. Findings: We find that screening individuals' BP in their homes and providing health information and a referral to those with elevated BP did not meaningfully improve hypertension diagnosis (0.1, p-value: 0.82), treatment (-0.2, p-value: 0.49), or BP levels (systolic: -1.8, p-value: 0.03; diastolic: 0.5, p-value: 0.39). This null effect is robust across subpopulations and alternative specifications. Interpretation: Our findings suggest that a lack of knowledge of one's hypertension status might not be the primary reason for low diagnosis and treatment rates in India, where other structural and behavioral barriers may be more relevant. Adapting screening efforts to address these additional barriers will be essential for translating India's screening efforts into improved population health.
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