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Int J Environ Res Public Health. 2019 Nov 19;16(22). pii: E4578. doi: 10.3390/ijerph16224578.

Trends and Inequalities in the Health Care and Hypertension Outcomes in China, 2011 to 2015.

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The Nossal Institute for Global Health, The University of Melbourne, Melbourne 3010, Australia.
WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, Melbourne 3010, Australia.
School of Health Services Management, Southern Medical University, Guangzhou 500000, Guangdong, China.


Background: Hypertension is one of the most significant and common risk factors for cardiovascular disease, yet it remains poorly controlled in China. This study aims to examine trends and socioeconomic inequalities in the management of hypertension between 2011 and 2015 in China and to investigate the association between antihypertensive medication treatment and reduction of blood pressure, using nationally representative data. Methods: Concentration curve and concentration index were used to assess socioeconomic-related inequalities in hypertension care and health service utilisation. The fixed-effects analysis was performed to measure the impact of medication treatment on reduction of blood pressure among people with hypertension by using linear regression models. Results: Among hypertensive individuals, there were growing trends in the rates of awareness and treatment from 55.87% and 48.44% in 2011, to 68.31% in 2013 and 61.97% in 2015, respectively. The proportion of hypertension control was still below 30%. The fixed-effects models indicated that medication treatment was statistically significant and associated with the patients' systolic blood pressure (β: -13.483; 95% CI: -15.672, -11.293) and diastolic blood pressure (β: -5.367; 95% CI: -6.390, -4.344). Conclusions: China has made good progress in the hypertension diagnosis, medication treatment and coverage of health services over the last 10 years; however, pro-rich inequalities in hypertension care still exist, and there is considerable progress to be made in the prevention, treatment and effective control of hypertension.


China; healthcare; hypertension; socioeconomic inequality; trends

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