{"abstracts":[{"sha1":"8be97c07ea70dec298086d506ce070c89cbde708","content":"\nBackground\nHypertension is the most important cardiovascular risk factor in India, and representative studies of middle-aged and older Indian adults have been lacking. Our objectives were to estimate the proportions of hypertensive adults who had been diagnosed, took antihypertensive medication, and achieved control in the middle-aged and older Indian population and to investigate the association between access to healthcare and hypertension management.\n\n\nMethods and findings\nWe designed a nationally representative cohort study of the middle-aged and older Indian population, the Longitudinal Aging Study in India (LASI), and analyzed data from the 2017–2019 baseline wave (N = 72,262) and the 2010 pilot wave (N = 1,683). Hypertension was defined as self-reported physician diagnosis or elevated blood pressure (BP) on measurement, defined as systolic BP ≥ 140 mm Hg or diastolic BP ≥ 90 mm Hg. Among hypertensive individuals, awareness, treatment, and control were defined based on self-reports of having been diagnosed, taking antihypertensive medication, and not having elevated BP, respectively. The estimated prevalence of hypertension for the Indian population aged 45 years and older was 45.9% (95% CI 45.4%–46.5%). Among hypertensive individuals, 55.7% (95% CI 54.9%–56.5%) had been diagnosed, 38.9% (95% CI 38.1%–39.6%) took antihypertensive medication, and 31.7% (95% CI 31.0%–32.4%) achieved BP control. In multivariable logistic regression models, access to public healthcare was a key predictor of hypertension treatment (odds ratio [OR] = 1.35, 95% CI 1.14–1.60, p = 0.001), especially in the most economically disadvantaged group (OR of the interaction for middle economic status = 0.76, 95% CI 0.61–0.94, p = 0.013; OR of the interaction for high economic status = 0.84, 95% CI 0.68–1.05, p = 0.124). Having health insurance was not associated with improved hypertension awareness among those with low economic status (OR = 0.96, 95% CI 0.86–1.07, p = 0.437) and those with middle economic status (OR of the interaction = 1.15, 95% CI 1.00–1.33, p = 0.051), but it was among those with high economic status (OR of the interaction = 1.28, 95% CI 1.10–1.48, p = 0.001). Comparing hypertension awareness, treatment, and control rates in the 4 pilot states, we found statistically significant (p < 0.001) improvement in hypertension management from 2010 to 2017–2019. The limitations of this study include the pilot sample being relatively small and that it recruited from only 4 states.\n\n\nConclusions\nAlthough considerable variations in hypertension diagnosis, treatment, and control exist across different sociodemographic groups and geographic areas, reducing uncontrolled hypertension remains a public health priority in India. Access to healthcare is closely tied to both hypertension diagnosis and treatment.\n","mimetype":"application/xml+jats"}],"refs":[{"index":0,"extra":{"authors":["NCD Risk Factor Collaboration (NCD–RisC)"],"doi":"10.1016/s0140-6736(16)31919-5","issue":"10064","volume":"389"},"key":"pmed.1003855.ref001","year":2017,"container_name":"Lancet","title":"Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19.1 million participants","locator":"37"},{"index":1,"extra":{"authors":["India State-Level Disease Burden Initiative CVD Collaborators"],"doi":"10.1016/s2214-109x(18)30407-8","issue":"12"},"key":"pmed.1003855.ref002","year":2018,"container_name":"Lancet Glob Health","title":"The changing patterns of cardiovascular diseases and their risk factors in the states of India: the Global Burden of Disease Study 1990–2016","locator":"e1339"},{"index":2,"extra":{"authors":["P Geldsetzer"],"doi":"10.1001/jamainternmed.2017.8094","volume":"178"},"key":"pmed.1003855.ref003","year":2018,"container_name":"JAMA Intern Med","title":"Diabetes and hypertension in India: a nationally representative study of 1.3 million adults","locator":"363"},{"index":3,"extra":{"authors":["R Gupta"],"doi":"10.1016/j.ihj.2018.02.003","volume":"70"},"key":"pmed.1003855.ref004","year":2018,"container_name":"Indian Heart J","title":"Hypertension: the most important non communicable disease risk factor in India","locator":"565"},{"index":4,"extra":{"authors":["SN Shah"],"issue":"2–3"},"key":"pmed.1003855.ref005","year":2019,"container_name":"Clin J Hypertens","title":"Indian guidelines on hypertension-IV (2019)"},{"index":5,"extra":{"authors":["R Anchala"],"doi":"10.1097/hjh.0000000000000146","volume":"32"},"key":"pmed.1003855.ref006","year":2014,"container_name":"J Hypertens","title":"Hypertension in India: a systematic review and meta-analysis of prevalence, awareness, and control of hypertension","locator":"1170"},{"index":6,"extra":{"authors":["SN Shah"],"doi":"10.1038/s41371-020-0349-x","issue":"11","volume":"34"},"key":"pmed.1003855.ref007","year":2020,"container_name":"J Hum Hypertens","title":"Indian guidelines on hypertension-IV (2019)","locator":"745"},{"index":7,"extra":{"authors":["S Ramakrishnan"],"doi":"10.1016/j.ihj.2019.09.012","volume":"71"},"key":"pmed.1003855.ref008","year":2019,"container_name":"Indian Heart J","title":"Prevalence of hypertension among Indian adults: results from the great India blood pressure survey","locator":"309"},{"index":8,"extra":{"authors":["J Prenissl"],"doi":"10.1371/journal.pmed.1002801","volume":"16"},"key":"pmed.1003855.ref009","year":2019,"container_name":"PLoS Med","title":"Hypertension screening, awareness, treatment, and control in India: a nationally representative cross-sectional study among individuals aged 15 to 49 years","locator":"e1002801"},{"index":9,"extra":{"authors":["GBD 2016 Healthcare Access and Quality Collaborators"],"doi":"10.1016/s0140-6736(18)30994-2","volume":"391"},"key":"pmed.1003855.ref010","year":2018,"container_name":"Lancet","title":"Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016","locator":"2236"},{"index":10,"extra":{"authors":["India State-Level Disease Burden Initiative Collaborators"],"doi":"10.1016/s0140-6736(17)32804-0","issue":"10111","volume":"390"},"key":"pmed.1003855.ref011","year":2017,"container_name":"Lancet","title":"Nations within a nation: variations in epidemiological transition across the states of India, 1990–2016 in the Global Burden of Disease Study","locator":"2437"},{"index":11,"extra":{"authors":["V Patel"],"doi":"10.1016/s0140-6736(15)00955-1","volume":"386"},"key":"pmed.1003855.ref012","year":2015,"container_name":"Lancet","title":"Assuring health coverage for all in India","locator":"2422"},{"index":12,"extra":{"authors":["PA James"],"doi":"10.1001/jama.2013.284427","volume":"311"},"key":"pmed.1003855.ref013","year":2014,"container_name":"JAMA","title":"2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8)","locator":"507"},{"index":13,"extra":{"authors":["AE Moran"],"doi":"10.1056/nejmsa1406751","volume":"372"},"key":"pmed.1003855.ref014","year":2015,"container_name":"N Engl J Med","title":"Cost-effectiveness of hypertension therapy according to 2014 guidelines","locator":"447"},{"index":14,"extra":{"authors":["MR Law"],"doi":"10.1136/bmj.b1665","volume":"338"},"key":"pmed.1003855.ref015","year":2009,"container_name":"BMJ","title":"Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies","locator":"b1665"},{"index":15,"extra":{"authors":["A Sakima"],"doi":"10.1038/s41440-018-0123-4","volume":"42"},"key":"pmed.1003855.ref016","year":2019,"container_name":"Hypertens Res","title":"Optimal blood pressure targets for patients with hypertension: a systematic review and meta-analysis","locator":"483"},{"index":16,"extra":{"unstructured":"National Programme for Health Care of Elderly, International Institute for Population Sciences, Ministry of Health and Family Welfare. Longitudinal Ageing Study in India (LASI): wave-1. India report. Mumbai: International Institute for Population Sciences; 2020 [cited 2021 Jan 26]. https://www.iipsindia.ac.in/sites/default/files/LASI_India_Report_2020_compressed.pdf."},"key":"pmed.1003855.ref017"},{"index":17,"extra":{"authors":["P Arokiasamy"],"volume-title":"Aging in Asia: findings from new and emerging data initiatives"},"key":"pmed.1003855.ref018","year":2012,"container_name":"Aging in Asia: findings from new and emerging data initiatives","locator":"36"},{"index":18,"extra":{"authors":["A Deaton"],"doi":"10.1596/0-8018-5254-4","volume-title":"The analysis of household surveys: a microeconometric approach to development policy"},"key":"pmed.1003855.ref019","year":1997,"container_name":"The analysis of household surveys: a microeconometric approach to development policy"},{"index":19,"extra":{"doi":"10.2139/ssrn.2650214","unstructured":"Lee J, Meijer E, Phillips D. The effect of using different imputation methods for economic variables in aging surveys. University of Southern California CESR–Schaeffer Working Paper Series. No. 2015–019. Los Angeles: University of Southern California Center for Economic and Social Research; 2015 [cited 2020 Oct 10]. https://cesr.usc.edu/documents/WP_2015_019.pdf."},"key":"pmed.1003855.ref020"},{"index":20,"extra":{"authors":["J Lee"],"volume-title":"Aging in Asia: findings from new and emerging data initiatives"},"key":"pmed.1003855.ref021","year":2012,"container_name":"Aging in Asia: findings from new and emerging data initiatives","locator":"389"},{"index":21,"extra":{"authors":["Office of the Registrar General and Census Commissioner"],"volume-title":"Single year age returns by residence and sex"},"key":"pmed.1003855.ref022","container_name":"Single year age returns by residence and sex"},{"index":22,"extra":{"authors":["Technical Group on Population Projections"],"volume-title":"Population projections for India and states, 2011–2036"},"key":"pmed.1003855.ref023","year":2020,"container_name":"Population projections for India and states, 2011–2036"},{"index":23,"extra":{"unstructured":"Ahmad OB, Boschi-Pinto C, Lopez AD, Murray CJL, Lozano R, Inoue M. Age standardization of rates: a new WHO standard. GPE Discussion Paper Series. No. 31. Geneva: World Health Organization; 2001 [cited 2017 Feb 6]. http://www.who.int/healthinfo/paper31.pdf."},"key":"pmed.1003855.ref024"},{"index":24,"extra":{"authors":["JD Angrist"],"doi":"10.1515/9781400829828","volume-title":"Mostly harmless econometrics"},"key":"pmed.1003855.ref025","year":2009,"container_name":"Mostly harmless econometrics"},{"index":25,"extra":{"authors":["University of Notre Dame"],"volume-title":"Using Stata's margins command to estimate and interpret adjusted predictions and marginal effects"},"key":"pmed.1003855.ref026","year":2021,"container_name":"Using Stata's margins command to estimate and interpret adjusted predictions and marginal effects"},{"index":26,"extra":{"unstructured":"StataCorp. Stata statistical software: release 14. College Station (TX): StataCorp; 2015."},"key":"pmed.1003855.ref027"},{"index":27,"extra":{"authors":["SK Mohanty"],"doi":"10.1371/journal.pmed.1003740","volume":"18"},"key":"pmed.1003855.ref028","year":2021,"container_name":"PLoS Med","title":"Awareness, treatment, and control of hypertension in adults aged 45 years and over and their spouses in India: a nationally representative cross-sectional study","locator":"e1003740"},{"index":28,"extra":{"authors":["D Nambiar"],"doi":"10.1371/journal.pone.0236169","volume":"15"},"key":"pmed.1003855.ref029","year":2020,"container_name":"PLoS ONE","title":"Monitoring universal health coverage reforms in primary health care facilities: creating a framework, selecting and field-testing indicators in Kerala, India","locator":"e0236169"},{"index":29,"extra":{"authors":["S Sriram"],"doi":"10.1186/s12913-020-05692-7","volume":"20"},"key":"pmed.1003855.ref030","year":2020,"container_name":"BMC Health Serv Res","title":"Effect of health insurance program for the poor on out-of-pocket inpatient care cost in India: evidence from a nationally representative cross-sectional survey","locator":"839"},{"index":30,"extra":{"authors":["P Muntner"],"doi":"10.1001/jama.2020.14545","issue":"12","volume":"324"},"key":"pmed.1003855.ref031","year":2020,"container_name":"JAMA","title":"Trends in blood pressure control among US adults with hypertension, 1999–2000 to 2017–2018","locator":"1190"},{"index":31,"extra":{"authors":["A Marshall"],"doi":"10.1136/jech-2014-205336","volume":"70"},"key":"pmed.1003855.ref032","year":2016,"container_name":"J Epidemiol Community Health","title":"Comparison of hypertension healthcare outcomes among older people in the USA and England","locator":"264"},{"index":32,"extra":{"authors":["X Lei"],"doi":"10.1016/j.jeoa.2014.10.001"},"key":"pmed.1003855.ref033","year":2014,"container_name":"J Econ Ageing","title":"Health outcomes and socio-economic status among the mid-aged and elderly in China: evidence from the CHARLS national baseline data","locator":"59"},{"index":33,"extra":{"authors":["National Health Portal"],"volume-title":"Ayushman Bharat Yojana"},"key":"pmed.1003855.ref034","year":2019,"container_name":"Ayushman Bharat Yojana"},{"index":34,"extra":{"authors":["R Baru"],"issue":"38","volume":"45"},"key":"pmed.1003855.ref035","year":2010,"container_name":"Econ Polit Wkly","title":"Inequities in access to health services in India: caste, class and religion","locator":"49"},{"index":35,"extra":{"authors":["B Bhargava"]},"key":"pmed.1003855.ref036","year":2018,"container_name":"Lancet","title":"Informing NCD control efforts in India on the eve of Ayushman Bharat"},{"index":36,"extra":{"authors":["K Chalkidou"],"volume-title":"CGD Note"},"key":"pmed.1003855.ref037","year":2019,"container_name":"CGD Note"},{"index":37,"extra":{"authors":["K Gangadharan"],"volume":"11"},"key":"pmed.1003855.ref038","year":2020,"container_name":"Indian J Public Health Res Dev","title":"Improving public health care in India through urban primary health centres—trends, progress and concerns","locator":"147"}],"contribs":[{"index":0,"creator_id":"nknjpdr7c5bw3j6l63lnhclpvy","creator":{"orcid":"0000-0002-6209-719X","surname":"Lee","given_name":"Jinkook","display_name":"Jinkook Lee","state":"active","ident":"nknjpdr7c5bw3j6l63lnhclpvy","revision":"025357b4-ce75-4d12-87ae-2040bce75898"},"raw_name":"Jinkook Lee","given_name":"Jinkook","surname":"Lee","role":"author","extra":{"seq":"first"}},{"index":1,"raw_name":"Jenny Wilkens","given_name":"Jenny","surname":"Wilkens","role":"author"},{"index":2,"creator_id":"pl3jthot4fez5nacbokycoyflq","creator":{"orcid":"0000-0001-7959-4670","surname":"Meijer","given_name":"Erik","display_name":"Erik Meijer","state":"active","ident":"pl3jthot4fez5nacbokycoyflq","revision":"c4aeae6e-4239-475f-bebd-6244b9e6ff84"},"raw_name":"Erik Meijer","given_name":"Erik","surname":"Meijer","role":"author"},{"index":3,"raw_name":"T. 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