Urban-rural disparities in hypertension prevalence, detection, and medication use among Chinese Adults from 1993 to 2011

Abstract

BackgroundChina has experienced a rapid increase in hypertension over the past decade, especially in rural. Therefore, the aim of this research is to examine the dynamic trends in urban-rural disparities in hypertension prevalence, detection, and medication use among Chinese adults from 1993 to 2011.MethodsData were extracted from the seven latest waves of the China Health and Nutrition Survey (CHNS). We used the hukou system to distinguish between urban and rural residents. Chi-square tests were performed to examine urban-rural gaps in hypertension prevalence, detection and medication use. Multiple logistic regressions were used to confirm these disparities and to explore whether the urban-rural gaps have narrowed or widened from 1993 to 2011, after controlling for health-related behaviors, BMI, demographic variables and socioeconomic characteristics. Blinder-Oaxaca decomposition technique was also used to calculate the extent to which urban-rural disparities reflect an endowments effect or a coefficients effect.ResultsHypertension prevalence, detection, and medication use among rural adults were significantly lower than urban adults, with the significant level at p < 0.001. The urban-rural gaps in hypertension prevalence and medication use gradually narrowed during the period 1993–2011, whereas the gaps in hypertension detection grew wider. After controlling for confounding variables, urban adults were about 24.5, 49.4, and 89.5% more likely to be hypertensive, detected, and medicated than their rural counterparts (p < 0.01), respectively. The Blinder-Oaxaca decomposition suggested that approximately 22 and 26% of the urban-rural gap in hypertension detection and medication use could be attributed to coefficient difference, respectively.ConclusionsAlthough hypertension prevalence among rural adults was comparable to that of urban adults, hypertension detection and medication use of rural adults were still suboptimal. Unusually large urban-rural gaps and an expanding trend in hypertension detection deserve the attention of health policymakers and researchers.

Spatiotemporal Variation of the Association between Urbanicity and Incident Hypertension among Chinese Adults

“…We did not include its cubic term, as the model fit had no significant improvement after including the term. Hukou, the household registration system in China, categorizes registered residents into agricultural and nonagricultural groups and determines the eligibility for public service and welfare benefits (e.g., education, health care) [35]. As a previous study found that the hukou type was associated with Int.…”

“…Res. Public Health 2020, 17, 304 5 of 17 prevalent HTN [35], we included it in our analyses to estimate the association between urbanicity and HTN onset, independent of the institutional effect of hukou. The CHNS only asked respondents about their hukou type from 1993.…”

Antihypertensive treatment and depressive symptoms in Chinese middle‐aged and older hypertensive adults: A population‐based longitudinal study

“…There is a great gap in hypertension management between urban and rural residence in China, 18,19 and the rate of monitoring and follow-up among rural hypertensive adults was lower than that of urban hypertensive adults, which was consistent with earlier findings. [34][35][36] Additionally, most of the health promotion activities, such as advocating rational use of drugs, and improving health behaviors like weight control, physical exercise, and healthy diet are commonly held in city communities, which caused a barrier to equal access for rural population. 37 Moreover, recent studies have indicated that although hypertension is typically asymptomatic and many patients look otherwise healthy, its inapposite detection and management may cause psychological stress since being diagnosed with hypertension were challenging to individuals' personality and caused a loss of self-esteem and therefore rendering patients psychologically stressful.…”

Internet Access and Hypertension Management Among the Elderly Population: A Nationally Representative Cross-Sectional Survey in China (Preprint)

“…In China, there is a growing epidemic of hypertension, among the population as a whole, and among urban and rural population specifically [2]. Over the past decades, lifestyle and dietary pattern have changed substantially in rural areas due to China's rapid economic growth and urbanization [3]. As a result, hypertension prevalence among rural population is getting close to that of their urban counterparts [3].…”

“…Over the past decades, lifestyle and dietary pattern have changed substantially in rural areas due to China's rapid economic growth and urbanization [3]. As a result, hypertension prevalence among rural population is getting close to that of their urban counterparts [3]. However, most of the health facilities and human resources are located in cites and urban areas [4].…”