中国高血压护理级联中的区域级社会经济不平等：基于中国心脏项目的全国性人口研究

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific Pub Date : 2025-04-01 DOI:10.1016/j.lanwpc.2025.101544

Wenyao Peng , Siqi Lin , Xuan Liu , Bowang Chen , Xueke Bai , Chaoqun Wu , Xiaoyan Zhang , Yang Yang , Jianlan Cui , Wei Xu , Lijuan Song , Hao Yang , Wenyan He , Yan Zhang , Xi Li , Jiapeng Lu

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引用次数: 0

摘要

社会经济地位（SES）是健康的关键社会决定因素之一。与个体水平的SES相比，区域水平的SES与高血压管理之间的关系一直没有得到充分的研究和认识。在本研究中，我们旨在评估区域水平SES与高血压意识、治疗、联合治疗和控制之间的关系，以及个体特征对这种关系的调节作用。方法选取2015年12月至2022年12月参加中国健康评估与风险降低全国团队合作（ChinaHEART）项目的31个省份的1559748名35-75岁高血压患者为研究对象。区域级SES的复合值是根据全国人口普查数据生成的，并按类别进行分类。拟合考虑县级行政区域随机效应的多变量混合模型，计算区域和个人水平SES与高血压管理（意识、治疗、联合治疗和控制）的独立和交互关联的比值比（OR）和95%置信区间（ci），以及它们在不同人群亚组之间的差异。结果在纳入的59·1±9.1岁高血压患者中，分别有794,675人（50.95%）、650,485人（41.70%）和206,103人（13.21%）被告知、接受治疗和得到控制。与高区域水平SES组相比，低区域水平SES组的高血压知知率（OR: 0.75, 95% CI: 0.65 ~ 0.86）、治疗（0.69、0.59 ~ 0.81）、联合治疗（0.65、0.51 ~ 0.84）和对照组（0.62、0.51 ~ 0.75）均显著降低。个体和地区经济地位低的参与者高血压管理的几率最低。在青年人和高SES个体中，区域SES水平对高血压认知、治疗和控制的影响较大，而对联合治疗的影响较弱。区域水平SES在高血压的认识、治疗、联合治疗和控制中起关键作用，且存在不同程度的关联。中国需要采取综合行动，改善地区状况，促进有针对性的高血压护理干预，以减少健康不平等。资助CAMS医学科学创新基金；国家高水平医院临床研究经费；国家自然科学基金；中国财政部、国家卫生健康委员会；中国教育部“111”项目

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Area-level socioeconomic inequalities in hypertension care cascade in China: a nationwide population-based study based on the ChinaHEART project

Background

Socioeconomic status (SES) is one of key social determinants of health. Compared to individual-level SES, the association between area-level SES and hypertension management has been understudied and under-recognised. In this study, we aimed to assess the association between area-level SES and hypertension awareness, treatment, combination therapy and control, and the modification effect of individual characteristics on the associations.

Methods

During Dec 2015 and Dec 2022, 1,559,748 residents with hypertension aged 35–75 years from 31 provinces in the China Health Evaluation And risk Reduction through nationwide Teamwork (ChinaHEART) were included. The composite value of area-level SES was generated from national census data and categorized into tertiles. Multivariable mixed models with random effects to account for county-level administrative area were fitted to compute odds ratios (OR) and 95% confidence intervals (CIs) for the independent and interactive associations of both area- and individual-level SES with hypertension management (awareness, treatment, combination therapy and control) and their disparities across different population subgroups.

Findings

Among the included participants with hypertension aged 59·1 ± 9·1 years, 794,675 (50·95%), 650,485 (41·70%) and 206,103 (13·21%) were aware, treated, and controlled, respectively. Compared with the high area-level SES group, the low group was significantly associated with a lower odds of hypertension awareness (OR: 0·75, 95% CI: 0·65–0·86), treatment (0·69, 0·59–0·81), combination therapy (0·65, 0·51–0·84), and control (0·62, 0·51–0·75). Participants with low SES at both individual and area level had the lowest odds of hypertension management. Area-level SES had stronger influences on hypertension awareness, treatment and control, but a weaker influence on combination therapy, in the young and those with high individual-level SES.

Interpretation

Area-level SES on plays a key role in the awareness, treatment, combination therapy and control of hypertension, with different magnitude of associations. Integrated action to improve area-level circumstances and promote targeted interventions to hypertension care cascade are needed to reduce health inequalities in China.

Funding

The CAMS Innovation Fund for Medical Science; the National High Level Hospital Clinical Research Funding; the National Natural Science Foundation of China of China; the Ministry of Finance of China and National Health Commission of China; the 111 Project from the Ministry of Education of China.

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来源期刊

The Lancet Regional Health: Western Pacific Medicine-Pediatrics, Perinatology and Child Health

CiteScore

8.80

自引率

2.80%

发文量

305

审稿时长

11 weeks

期刊介绍： The Lancet Regional Health – Western Pacific, a gold open access journal, is an integral part of The Lancet's global initiative advocating for healthcare quality and access worldwide. It aims to advance clinical practice and health policy in the Western Pacific region, contributing to enhanced health outcomes. The journal publishes high-quality original research shedding light on clinical practice and health policy in the region. It also includes reviews, commentaries, and opinion pieces covering diverse regional health topics, such as infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, aging health, mental health, the health workforce and systems, and health policy.