Summaryobjective To examine how socioeconomic differences are related to the prevalence, awareness and treatment of diabetes in rural Yunnan province, a relatively undeveloped province in southwest China.methods A cross-sectional survey was conducted from 2008 to 2010; 10 007 consenting individuals aged ‡18 years were selected to participate in the study using a stratified, multistage sampling technique. Information about participants' demographic characteristics, smoking habits, drinking habits, awareness and treatment of diabetes, and family history of diabetes were obtained using a standard questionnaire. Height, weight, waist circumference, hip circumference, fasting blood sugar level and blood pressure were also measured for each individual. Data were analysed using multivariate logistic regression.results The age-standardised presence of diabetes was 6.8% in the study population. In diabetic subjects, 28.7% were aware that they had diabetes, and 22.6% had received treatment. After controlling for age, sex, smoking behaviour, drinking behaviour, hypertension, being overweight, central obesity and family history of diabetes, individual educational level was negatively associated with the prevalence of diabetes and positively associated with the awareness and treatment of diabetes. The awareness and treatment of diabetes showed a negative relationship with ethnic minority status and a positive relationship with individual household income.conclusions There are low levels of awareness and treatment among individuals living with diabetes in rural southwest China. Strategies that can enhance public awareness of diabetes and increase access to affordable medications are urgently needed, especially for poor, less educated individuals who belong to ethnic minorities.

Abstractobjective To estimate the economic burden of hypertension in a given year in rural Yunnan Province of China, including direct, indirect and intangible costs.methods A prevalence-based cost-of-illness method was used to estimate the economic burden of hypertension. Data on participants' demographic characteristics, inpatient hospitalisation expenditures, outpatient visit expenditures, self-medication costs and indirect costs related to hypertension were collected from a cross-sectional health examination and questionnaire survey, involving 9396 consenting individuals aged ‡18 years and 3500 households. Blood pressure (BP) levels were determined from the average of three BP measurements. Years of life lost (YLL) because of hypertension was estimated using medical death certificates.results The overall prevalence of and YLL ⁄ 1000 population because of hypertension was 24.8% and 1.5 years for the survey population, respectively. Mean unit direct medical costs, direct non-medical costs, morbidity costs, mortality costs, intangible costs and cost of illness were estimated to be $467.2, $20.1, $23.5, $8265.1, $417.4 and $9393.3, respectively. The total cost of hypertension was estimated to be $231.7 million. Direct costs represented the largest component of economic cost of hypertension. On average, males had higher overall direct, indirect and intangible costs of hypertension than females. Both indirect and intangible costs decreased with age, whereas direct costs increased with age. The incidence of household catastrophic health payment and household impoverishment because of hypertension was 8.9% and 4.1%, respectively.

This article on determinants of pre-hypertension and hypertension in rural southwest China is an interesting study with more than 11,000 subjects. The finding that pre-hypertension is more prevalent than hypertension provides evidence of the need for early intervention in the population and intervention strategies that are appropriate for the diverse ethnic groups that exist within the population. As the authors note, the prevalence of hypertension has risen in the last decade in China. This increase follows a worldwide trend regarding the growing burden of noncommunicable diseases as a serious public health concern; moreover, half of all noncommunicable disease deaths worldwide are cardiovascular in nature. Le and colleagues were able to recruit a very large population for this study and maintain a high level of participationmore than 94%. This study does not show the strong relationship to individual income that is reported in many studies; however, it does demonstrate the importance of ethnicity as it relates to pre-hypertension and hypertension. The authors suggest that genetic factors, various diet-related factors, and lifestyles may be more important determinants for blood pressure levels than individual income. What is significant in this study is that the size provides an opportunity to look at differences within what might appear to be a fairly homogenous population. In fact, the population is quite diverse, and the diversity provides evidence of the need for more tailored interventions for reducing pre-hypertension and hypertension.