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Hypertension is a major cardiovascular risk factor and an important public health challenge worldwide. Globally, nearly 1.13 billion people have hypertension but less than 20% have their condition under control (1). The prevalence of hypertension among adults in China increased substantially from 18% to 23.2% between 2002 and 2012 (2). The awareness, treatment, and control of hypertension have been increasingly emphasized, but previous studies mainly focused on the overall population and knowledge about some specific populations such as the labor force population is limited. The labor force population was defined as 18–59 years old according to the Labor Law of the People’s Republic of China. This study aimed to provide updated and reliable data on the prevalence, awareness, treatment, control and associated factors of hypertension among the labor force population in China using data from a nationally representative sample of Chinese adults.
This study used the China Chronic Disease and Nutrition Surveillance (CCDNS) in 2015, which used 298 surveillance points across 31 provincial-level administrative divisions (PLADs) and used a multi-stage stratified cluster randomized sampling method to select a representative sample of households. Local CDC invited eligible residents aged 18 years and above in the selected households to participate. Similar recruitment methods used in the CCDNS were reported elsewhere (3). Of the 88,250 households sampled, 123,155 subjects fulfilled criteria for being in the labor force population aged 18–59 years. We excluded 5,172 participants with missing systolic blood pressure (SBP) or diastolic blood pressure (DBP). Finally, 117,983 participants were included in the present analysis.
SBP and DBP were measured 3 times with a one-minute interval with an electronic sphygmomanometer (Omron HBP 1300) after the subjects had rested for 5 minutes in sitting position. Three readings of SBP and DBP were recorded and the average of the last two readings was used for data analysis. Information on sociodemographic characteristics (sex, age, residential area, educational level, and income), behavioral risk factors for chronic diseases (smoking, alcohol consumption, physical activity, salt intake), and body mass index (BMI) were collected through a questionnaire by face-to-face interviews with trained interviewers.
Hypertension was defined as SBP≥140 mmHg or DBP≥90 mmHg, or based on self-reported diagnosis of hypertension in hospitals at the township (community) level hospitals or above and had been taking anti-hypertensive medicine in the last 2 weeks. Awareness of hypertension was defined as a self-report of any previously diagnosed hypertension by health professionals.
Treatment of hypertension was limited to those with SBP≥140 mmHg or DBP≥90 mmHg in this surveillance and also self-reported taking a prescribed anti-hypertensive medicine over the past 2 weeks. Control of hypertension was defined as having measured SBP<140 mmHg and DBP<90 mmHg among those with hypertension at survey.
Prevalence rates (with 95% CI①) were estimated for all and for subgroups. Sampling weights were applied to all statistical descriptions and inferences to get nationally representative estimates. The post-stratification adjustment used the 2015 Chinese population estimates from the National Bureau of Statistics. Rao-Scott chi-square tests were conducted to test for group differences in prevalence. Logistic regression models were used to examine the trends for ordered categorical variables. Multivariable logistic regression models were fit to explore the factors associated with prevalence, awareness, treatment, and control of hypertension. All statistical analyses were conducted using SAS software (version 9.4, SAS Institute Inc., Cary, USA).
Overall, 21.4% (95% CI: 20.2%–22.6%) of the study population had hypertension, including 17.2% (95% CI: 16.1%–18.3%) newly diagnosed hypertension and 4.2% (95% CI: 3.9%–4.5%) self-reported hypertension. The prevalence of hypertension was significantly higher among men than women (25.3% vs. 17.4%, p<0.05) and was higher among rural residents than urban residents (23.1% vs. 19.9%, p<0.05). Hypertension prevalence increased with age, BMI, salt intake, and alcohol consumption and decreased with education level and annual household income per capita. The awareness, treatment, and control of hypertension were 26.1%, 19.6%, and 6.3%, respectively. The awareness, treatment, and control were higher among women than men (30.2% vs. 23.3% for awareness, p<0.05; 23.6% vs. 16.8% for treatment, p<0.05; 7.7% vs. 5.4% for the control, p<0.05). It was also higher in older participants, urban residents, overweight and obese patients. (Table 1)
Characteristics Prevalence Awareness Treatment Control Newly diagnosed
(%) (95% CI)*p value† Self-reported
(%) (95% CI)p value Total
(%) (95% CI)p value (%) (95% CI) p value (%) (95% CI) p value (%) (95% CI) p value Total 17.2(16.1−18.3) − 4.2(3.9−4.5) − 21.4(20.2−22.6) − 26.1(24.6−27.6) − 19.6(18.2−20.9) − 6.3(5.6−7.0) − Age (years) 18−44 12.4(11.3−13.5) <0.05 1.5(1.3−1.7) <0.05 13.9(12.7−15.1) <0.05 16.0(14.4−17.7) <0.05 10.5(9.3−11.7) <0.05 3.7(3.0−4.3) <0.05 45−59 28.4(27.3−29.6) 10.6(10.0−11.3) 39.1(37.9−40.2) 34.5(32.8−36.2) 27.2(25.5−28.8) 8.5(7.6−9.4) Sex Male 21.0(19.6−22.5) <0.05 4.3(3.9−4.6) 0.4439 25.3(23.7−26.8) <0.05 23.3(21.6−24.9) <0.05 16.8(15.4−18.2) <0.05 5.4(4.7−6.1) <0.05 Female 13.3(12.4−14.2) 4.1(3.8−4.4) 17.4(16.5−18.4) 30.2(28.4−32.0) 23.6(21.9−25.3) 7.7(6.7−8.7) Residential area Urban 15.5(14.0−16.9) <0.05 4.5(4.0−4.9) <0.05 19.9(18.2−21.6) <0.05 29.0(26.8−31.1) <0.05 22.4(20.5−24.2) <0.05 8.4(7.3−9.4) <0.05 Rural 19.2(18.2−20.2) 3.9(3.6−4.2) 23.1(22.1−24.0) 23.2(21.7−24.7) 16.8(15.4−18.2) 4.3(3.6−4.9) Educational level Illiterate or primary school 22.5(21.2−23.9) <0.05 5.4(4.9−6.0) <0.05 28.0(26.7−29.3) <0.05 26.4(24.3−28.5) 0.9494 19.4(17.3−21.5) 0.1823 5.6(4.4−6.8) <0.05 Junior high school 18.2(17.1−19.3) 4.1(3.6−4.6) 22.3(21.1−23.5) 25.0(22.9−27.1) 18.4(16.5−20.3) 5.5(4.6−6.4) Senior high school 14.8(13.0−16.6) 4.4(3.8−5.0) 19.2(17.0−21.4) 28.6(26.1−31.1) 22.9(20.7−25.0) 8.3(7.0−9.6) College and above 9.4(8.3−10.6) 2.2(1.7−2.7) 11.7(10.4−13.0) 24.6(20.2−29.0) 19.1(15.5−22.7) 8.7(6.4−11.0) Annual household income per capita (￥) <7,500 19.4(18.1−20.7) <0.05 4.3(3.8−4.5) 0.0892 23.6(22.3−24.9) <0.05 24.1(22.1−26.1) <0.05 17.7(15.9−19.4) <0.05 4.4(3.5−5.3) <0.05 7,500−15,000 18.9(17.8−20.1) 4.4(4.0−4.8) 23.3(22.2−24.5) 25.4(23.4−27.4) 18.9(17.1−20.6) 5.7(4.7−6.6) 15,001−25,000 18.1(16.9−19.3) 4.2(3.7−4.6) 22.3(21.4−23.6) 26.3(24.1−28.5) 18.7(16.8−20.5) 6.1(5.2−7.1) >25,000 14.5(12.5−16.4) 4.7(4.0−5.4) 19.2(16.8−21.6) 31.4(28.8−34.1) 24.6(22.2−27.0) 9.0(7.6−10.4) Body weight status (BMI categories) Underweight, BMI<18.5 5.0(3.7−6.2) <0.05 0.7(0.5−1.0) <0.05 5.7(4.4−7.1) <0.05 18.1(13.2−22.9) <0.05 13.0(8.9−17.0) <0.05 3.6(1.4−5.8) 0.5053 Normal weight, BMI: 18.5−23.9 10.8(9.9−11.7) 1.9(1.7−2.1) 12.6(11.7−13.6) 20.4(18.4−22.3) 14.8(13.2−16.4) 5.9(4.9−6.9) Overweight, BMI: 24−27.9 21.8(20.6−23.) 5.6(5.1−6.0) 27.4(26.1−28.6) 26.9(25.2−28.5) 20.4(18.8−21.9) 6.8(5.9−7.7) Obesity, BMI≥28 32.5(30.7−34.4) 10.0(9.2−10.8) 42.5(40.8−44.3) 31.0(28.7−33.3) 23.5(21.5−25.6) 6.0(4.9−7.2) Smoking Never 15.2(14.2−16.2) <0.05 4.0(3.7−4.2) 0.1604 19.1(18.1−20.2) <0.05 26.6(25.1−28.2) <0.05 20.7(19.2−22.1) <0.05 6.6(5.7−7.4) <0.05 Former smoker 25.0(22.8−27.3) 9.7(8.4−11.0) 34.7(32.7−36.8) 36.9(32.8−41.1) 28.0(24.2−31.8) 9.6(6.6−12.7) Current smoker 21.1(19.5−22.8) 4.0(3.5−4.5) 25.1(23.3−26.9) 23.0(20.9−25.1) 15.9(14.2−17.6) 5.2(4.4−6.0) Excessive drinking§ Yes 31.5(29.1−33.9) <0.05 5.7(4.9−6.6) <0.05 37.3(34.7−39.8) <0.05 24.0(21.6−26.4) 0.0491 15.4(13.2−17.6) <0.05 4.4(3.3−5.4) <0.05 No 15.9(14.9−17.0) 4.1(3.8−4.3) 20.0(18.9−21.1) 26.4(24.9−27.9) 20.3(18.9−21.6) 6.6(5.9−7.4) Excessive salt intake§ Yes 19.7(18.5−20.8) <0.05 4.6(4.19−4.9) <0.05 24.2(23.0−25.4) <0.05 25.8(24.0−27.6) 0.3497 18.8(17.3−20.4) <0.05 5.5(4.7−6.2) <0.05 No 14.7(13.5−15.9) 3.8(3.57−4.1) 18.6(17.2−19.9) 26.7(24.9−28.5) 20.7(19.1−22.4) 7.5(6.3−8.6) Lack of physical activity§ Yes 16.7(15.4−18.1) 0.2978 3.5(3.2−3.8) <0.05 20.2(18.9−21.6) 0.0127 22.6(20.5−24.7) 0.0001 17.2(15.4−19.1) <0.05 5.47(4.6−6.4) 0.0827 No 17.3(16.2−18.5) 4.4(4.1−4.7) 21.7(20.4−22.9) 26.9(25.4−28.5) 20.2(18.8−21.5) 6.50(5.7−7.3) * CI, confidence interval.
† Rao-scott chi-square tests were conducted to test for differences in prevalence for unordered categorical variables and logistic regression models were used to examine the trends for ordered categorical variables.
§ According to the Dietary Guidelines for Chinese Residents, excessive drinking was defined as an average daily alcohol intake of at least 25 g for males and 15 g for females. Excessive salt intake was defined as an average daily intake more than 6 g. Physical activity insufficiency was defined as the length of moderate and high intensity activity less than 150 minutes per week.Table 1. Prevalence, awareness, treatment, and control of hypertension in the labor force population in China, 2015.
The treatment rate among those who were aware of their hypertension status was 75.1% (95% CI: 73.1%–77.0%). The control rate of hypertension among those receiving treatment was 32.2% (95% CI: 30.0%–34.4%). The treatment rate among those who were aware of their hypertension status increased with age (p<0.05) but decreased for the control among those receiving anti-hypertensive treatment. Compared with people in rural areas, hypertensive participants in urban areas tended to get more treatment among those who were aware of their hypertension status and had better control among those receiving treatment (p<0.05). (Table 2)
Characteristics Treatment rate of hypertensive patients who were aware of
their condition (%) (95% CI)*Control rate of those patients who received
hypertension treatment (%) (95% CI)Treatment by medical order p value† Treatment by symptoms p value Total p value Treatment by medical order p value Treatment by symptoms p value Total p value Total 73.7(72.2−75.8) − 9.9(8.5−11.2) − 75.1(73.1−77.0) − 29.7(27.4−32.1) − 1.5(1.0−1.9) − 32.2(30.0−34.4) − Age (years) 18−44 65.6(61.8−69.3) <0.05 9.7(7.4−12.1) 0.8797 65.5(61.6−69.3) <0.05 30.3(25.7−34.8) 0.7839 1.8(0.6−3.00) 0.4220 34.8(30.5−39.2) 0.2156 45−59 77.2(75.4−79.1) 9.9(8.5−11.4) 78.8(76.9−80.7) 29.5(27.3−31.7) 1.3(0.9−1.8) 31.3(29.1−33.5) Sex Male 70.8(68.4−73.3) <0.05 9.3(7.7−10.8) 0.2457 72.3(69.7−74.9) <0.05 29.1(26.3−32.0) 0.5366 1.4(0.7−2.1) 0.7862 31.3(29.1−34.6) 0.7261 Female 77.5(75.3−79.8) 10.6(8.6−12.6) 78.3(75.9−80.6) 30.3(27.5−33.1) 1.5(1.0−2.01) 32.5(29.8−35.3) Residence Urban 75.9(73.7−78.1) <0.05 7.9(6.4−9.5) <0.05 77.2(74.6−79.7) <0.05 35.4(31.8−39.0) <0.05 0.9(0.4−1.5) <0.05 37.4(34.1−40.7) <0.05 Rural 71.6(68.7−74.5) 12.3(10.3−14.3) 72.5(69.9−75.0) 22.3(19.9−24.7) 2.1(1.5−2.8) 25.3(22.8−27.8) Educational level Illiterate or primary school 72.5(69.5−75.5) 0.0543 12.6(10.4−14.9) <0.05 73.5(70.3−76.7) <0.05 26.2(22.0−30.3) <0.05 1.6(1.0−2.2) 0.2149 28.9(24.8−33.0) <0.05 Junior high school 72.4(69.1−75.8) 9.8(7.4−12.2) 73.5(70.4−76.7) 27.6(23.9−31.3) 1.6(0.8−2.4) 29.8(26.0−33.6) Senior high 79.3(76.1−82.5) 6.7(4.9−8.5) 79.9(76.5−83.4) 34.8(30.9−38.6) 1.3(0.3−2.3) 36.2(32.4−40.0) College and above 74.9(67.8−82.1) 5.8(2.6−9.0) 77.7(72.4−83.1) 40.5(32.0−49.1) 0.7(0.5−1.8) 45.4(36.7−54.1) Annual household income per capita (￥) <7,500 72.9(69.0−76.8) 0.0664 11.2(8.8−13.5) <0.05 73.2(69.9−76.4) <0.05 21.4(18.0−24.9) <0.05 1.9(0.8−3.0) 0.8742 25.0(21.4−28.5) <0.05 7,500−15,000 74.8(71.8−77.8) 10.2(8.0−12.4) 74.2(71.0−77.4) 28.2(24.1−32.3) 1.2(0.6−1.9) 30.1(26.2−34.0) 15,001−25,000 69.4(65.5−73.4) 9.6(7.0−12.2) 71.0(66.8−75.1) 30.8(26.6−35.0) 1.3(0.6−2.0) 32.5(28.2−36.8) >25,000 78.3(75.4−81.4) 6.8(5.1−8.4) 78.4(75.4−81.4) 33.2(28.9−37.5) 1.6(0.5−2.7) 36.6(32.5−40.6) Body weight status (BMI categories) Underweight, BMI<18.5 68.3(52.9−74.9) 0.3709 13.3(6.2−20.4) 0.2927 71.9(60.3−83.4) 0.1782 23.5(9.7−37.4) <0.05 2.0(0.5−5.0) <0.05 27.6(13.9−41.4) <0.05 Normal weight, BMI: 18.5−23.9 73.0(69.3−76.7) 11.5(8.3−14.8) 72.6(68.7−76.6) 37.0(32.6−41.5) 1.7(0.9−2.6) 39.8(35.5−44.1) Overweight, BMI: 24−27.9 74.2(71.5−77.0) 9.2(7.5−10.9) 75.7(72.9−78.5) 30.4(27.5−33.3) 1.8(1.1−2.6) 33.6(30.5−36.6) Obesity, BMI≥28 74.6(71.5−77.6) 9.6(7.8−11.4) 75.9(72.9−78.9) 24.4(20.5−28.3) 0.8(0.4−1.3) 25.7(21.7−29.7) Smoking Never 76.6(74.5−78.1) <0.05 10.0(8.3−11.6) 0.9846 77.7(75.7−79.7) <0.05 29.6(26.7−43.5) 0.7970 1.4(0.9−1.9) 0.7015 31.7(28.9−34.6) 0.6477 Former smoker 72.5(66.2−78.8) 8.6(5.4−11.8) 75.7(69.8−81.5) 28.5(21.6−35.3) 2.0(0.4−4.5) 34.5(26.8−42.2) Current smoker 68.6(65.3−71.9) 10.1(8.2−12.0) 69.2(66.0−72.3) 30.3(26.9−33.8) 1.5(0.67−2.29) 32.5(29.0−36.0) Excessive drinking§ Yes 65.3(60.2−70.3) <0.05 10.7(7.6−13.8) 0.5559 64.2(59.4−69.0) <0.05 27.7(22.1−33.3) 0.4551 0.4(0.1−0.6) <0.05 28.3(22.7−34.0) 0.1595 No 75.3(73.4−77.1) 9.8(8.4−11.2) 76.7(74.7−78.7) 30.0(27.6−32.4) 1.6(1.1−2.1) 32.7(30.4−34.9) Excessive salt intake§ Yes 71.3(69.0−73.6) <0.05 11.5(9.5−13.4) <0.05 72.9(70.6−75.3) <0.05 26.2(23.7−28.7) <0.05 1.6(1.0−2.1) 0.7235 28.9(26.3−31.6) <0.05 No 77.4(74.7−80.2) 7.8(6.2−9.4) 77.8(74.6−80.9) 33.8(29.9−37.7) 1.4(0.7−2.1) 36.1(32.2−39.9) Lack of physical activity§ Yes 72.6(68.4−76.8) 0.4445 10.3(7.5−13.2) 0.7284 76.3(72.5−80.0) 0.4937 29.6(25.7−33.5) 0.9519 1.3(0.1−2.6) 0.7903 31.7(27.8−35.6) 0.8490 No 74.3(72.4−76.2) 9.8(8.4−11.2) 74.8(72.8−76.9) 29.7(27.2−32.2) 1.5(1.0−2.0) 32.2(29.8−34.7) * CI, confidence interval.
† Rao-Scott chi-square tests were conducted to test for differences in prevalence for unordered categorical variables and logistic regression models were used to examine the trends for ordered categorical variables.
§ According to the Dietary Guidelines for Chinese Residents, excessive drinking was defined as an average daily alcohol intake of at least 25 g for males and 15 g for females. Excessive salt intake was defined as an average daily intake more than 6 g. Physical activity insufficiency was defined as the length of moderate and high intensity activity less than 150 minutes per week.Table 2. Treatment rate of hypertensive patients who were aware of their condition and control rate of those patients who received hypertension treatment in the labor force population in China, 2015.
Logistic regression analysis in males and females showed that age, educational level, BMI, alcohol consumption and salt intake were associated with hypertension. Residential area and annual household income per capita were not associated with hypertension, but were associated with the awareness, treatment, and control of hypertension in both males and females. Prevalence of hypertension was higher in current smokers (25.1%) and former smokers (34.7%) than in never smokers (19.1%). However, when adjusted for other factors, current male smokers appeared to have a slightly lower hypertension rate (OR=0.90, 95% CI: 0.81–0.99) while there was no significance in females. (Table 3)
Characteristics Having hypertension Awareness Treatment Control OR(95% CI)* p value OR(95% CI) p value OR(95% CI) p value OR(95% CI) p value Male Age (years) (ref: 18−44) 45−59 2.70(2.47−2.95) <0.05 2.75(2.34−3.23) <0.05 3.42(2.85−4.10) <0.05 2.79(2.03−3.82) <0.05 Residential area (ref: Urban) Rural 0.95(0.85−1.05) 0.3037 0.77(0.65−0.91) <0.05 0.75(0.64−0.88) <0.05 0.61(0.47−0.79) <0.05 Educational level (ref: Illiterate or primary school) Junior high school 1.01(0.91−1.13) 0.7974 1.18(0.99−1.41) 0.0660 1.27(1.01−1.59) <0.05 1.25(0.90−1.74) 0.1755 Senior high 0.87(0.75−1.01) 0.0693 1.24(0.97−1.58) 0.0851 1.49(1.17−1.91) <0.05 1.32(0.88−1.96) 0.1780 College and above 0.77(0.65−0.91) <0.05 1.47(0.99−2.18) 0.0558 1.70(1.11−2.59) <0.05 2.09(1.24−3.53) <0.05 Annual household income per capita (￥) (ref: <7,500) 7,500−15,000 0.94(0.84−1.05) 0.2424 0.99(0.84−1.18) 0.9149 0.91(0.75−1.10) 0.3031 0.94(0.63−1.41) 0.7776 15,001−25,000 0.98(0.86−1.11) 0.7285 1.06(0.84−1.35) 0.6034 0.91(0.73−1.13) 0.3836 1.05(0.70−1.58) 0.8121 >25,000 0.87(0.72−1.04) 0.1172 1.37(1.10−1.71) <0.05 1.33(1.03−1.72) <0.05 1.65(1.09−2.49) <0.05 Body weight status (BMI categories) (ref: BMI: 18.5−23.9) Underweight, BMI<18.5 0.46(0.35−0.62) <0.05 0.69(0.46−1.03) 0.0663 0.75(0.47−1.19) 0.2242 1.79(0.68−4.68) 0.2371 Overweight, BMI:24−27.9 2.17(1.99−2.36) <0.05 0.99(0.68−1.47) 0.9901 1.08(0.68−1.70) 0.7501 1.89(0.77−4.63) 0.1670 Obesity, BMI≥28 5.04(4.49−5.66) <0.05 1.39(0.90−2.14) 0.1344 1.42(0.88−1.26) 0.1523 1.44(0.57−3.68) 0.4442 Smoking (ref: Never smoking) Former smoker 1.22(1.03−1.44) <0.05 2.15(1.74−2.65) <0.05 1.87(1.47−2.36) <0.05 2.33(1.46−3.72) <0.05 Current smoker 0.90(0.81−0.99) <0.05 1.25(1.07−1.45) <0.05 1.05(0.88−1.26) 0.5890 1.25(0.94−1.65) 0.1216 Excessive drinking (ref: No)† Yes 1.82(1.69−1.97) <0.05 0.96(0.84−1.10) 0.5768 0.84(0.70−1.01) 0.0562 0.75(0.55−1.04) 0.0798 Excessive salt intake (ref: No)† Yes 1.14(1.04−1.26) <0.05 1.00(0.86−1.17) 0.9694 0.97(0.84−1.12) 0.6867 0.96(0.72−1.28) 0.7798 Lack of physical activity (ref: No)† Yes 1.01(0.90−1.14) 0.8403 0.79(0.66−0.93) <0.05 0.78(0.65−0.94) <0.05 0.75(0.56−1.01) 0.0542 Female Age (years) (ref: 18−44) 45−59 4.46(4.05−4.91) <0.05 2.69(2.30−3.16) <0.05 3.12(2.61−3.73) <0.05 2.31(1.61−3.32) <0.05 Residential area (ref: Urban) Rural 0.99(0.89−1.10) 0.8977 0.90(0.77−1.06) 0.2255 0.86(0.72−1.04) 0.1193 0.60(0.44−0.82) <0.05 Educational level (ref: Illiterate or primary school) Junior high school 0.74(0.66−0.83) <0.05 1.01(0.85−1.20) 0.9065 1.08(0.89−1.31) 0.4492 1.08(0.75−1.55) 0.6982 Senior high 0.63(0.55−0.72) <0.05 1.09(0.85−1.39) 0.4931 1.12(0.85−1.46) 0.4247 1.32(0.87−1.99) 0.1920 College and above 0.41(0.32−0.52) <0.05 0.68(0.42−1.11) 0.1200 0.77(0.46−1.29) 0.3196 1.27(0.60−2.69) 0.5258 Annual household income per capita (￥) (ref: <7,500) 7,500−15,000 1.06(0.94−1.20) 0.3589 1.07(0.89−1.28) 0.5054 1.12(0.92−1.38) 0.2576 1.45(0.98−2.12) 0.0604 15,001−25,000 0.91(0.81−1.03) 0.1450 1.12(0.94−1.32) 0.1982 1.08(0.91−1.29) 0.3746 1.34(0.97−1.86) 0.0775 >25,000 0.93(0.79−1.08) 0.3315 1.30(1.07−1.58) <0.05 1.37(1.11−1.70) <0.05 1.63(1.18−2.27) <0.05 Body weight status (BMI categories) (ref: BMI: 18.5−23.9) Underweight, BMI<18.5 0.63(0.48−0.84) <0.05 2.20(1.34−3.63) <0.05 2.08(1.16−3.74) <0.05 1.83(0.62−5.37) 0.2745 Overweight, BMI:24−27.9 2.36(2.18−2.56) <0.05 2.68(1.64−4.35) <0.05 2.52(1.42−4.47) <0.05 1.53(0.53−4.38) 0.4325 Obesity, BMI ≥28 5.09(4.54−5.71) <0.05 3.86(2.34−6.38) <0.05 3.76(2.07−6.83) <0.05 1.95(0.62−6.14) 0.2566 Smoking (ref: Never smoking) Former smoker 0.92(0.54−1.55) 0.7418 1.41(0.65−3.04) 0.3870 1.39(0.61−3.16) 0.4392 1.45(0.65−3.22) 0.3630 Current smoker 0.86(0.69−1.08) 0.1823 1.17(0.82−1.67) 0.3946 1.36(0.92−2.00) 0.1206 2.21(1.41−3.48) <0.05 Excessive drinking (ref: No)† Yes 0.92(0.68−1.25) 0.5872 0.48(0.34−0.67) <0.05 0.38(0.26−0.56) <0.05 0.16(0.06−0.42) <0.05 Excessive salt intake (ref: No)† Yes 1.17(1.06−1.29) <0.05 0.87(0.75−1.01) 0.0603 0.85(0.71−1.01) 0.0628 0.66(0.52−0.84) <0.05 Lack of physical activity (ref: No)† Yes 0.99(0.88−1.13) 0.9741 0.95(0.78−1.17) 0.6450 1.04(0.86−1.27) 0.6775 1.23(0.85−1.78) 0.2807 * CI, confidence interval.
† According to the Dietary Guidelines for Chinese Residents, excessive drinking was defined as an average daily alcohol intake of at least 25 g for males and 15 g for females. Excessive salt intake was defined as an average daily intake more than 6 g. Physical activity insufficiency was defined as the length of moderate and high intensity activity less than 150 minutes per week.Table 3. Associations between factors and hypertension awareness, treatment, and control among male and female labor force populations in China, 2015.
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The findings from this study showed that the burden of hypertension and lack of treatment and management in China are serious threats to public health. The labor force population bears dual responsibilities from the society and the family and is also the foundation and driving force of the sustainable development of the country. The health of the labor force is related to socioeconomic development and is also key to preventing and reducing chronic diseases of the elderly population in the future. This study showed that about one-fifth of the labor force population in China had hypertension and only one-third of them were aware of their condition. In addition, about 4 out of 5 did not receive anti-hypertensive medication, resulting in an overall control rate of less than 10%.
The prevalence of hypertension in the labor force population was higher than that in 2002, with 13.9% vs. 9.1% and 39.1% vs. 29.3% in the age groups of 18–44 years and 45–59 years, respectively. The awareness and control rates of hypertension among those receiving treatment of hypertension have improved markedly compared with the results of the 2002 China National Nutrition and Health Survey (4). However, awareness and control rates are much lower than those in the developed world. In European countries, less than 20% of people with hypertension were unaware of their conditions, and less than 50% of patients did not control their hypertension effectively (5-6). Moreover, the awareness, treatment, and control rates among the labor force population were worse than those in some Asian countries such as Japan and Republic of Korea (7-8). These disparities are partly due to barriers in the health care system such as lack of access to care, low patient health literacy, and costly medications in different development levels.
Among hypertensive patients, only 20% of the hypertensive population were self-reported and 17.2% were newly diagnosed with hypertension indicating that hypertension remained largely undetected partly because many patients experienced almost no symptoms and were unaware of their condition. This is especially true in rural areas where blood pressure measurements during the first visit and routine blood pressure screening among communities is underutilized. The multivariable logistic regression models showed that although the prevalence between urban and rural areas had no significance, labor force population in rural areas had lower odds for awareness, treatment, and control rates. Moreover, rural residents had higher control rates among treated hypertensive participants by symptoms but lower control rates among treated hypertensive participants by medical order compared with counterparts in urban areas. This could be explained by the difference in the socioeconomic conditions and the access and quality of health services.
Age is one of the factors that affects the prevalence, awareness, treatment, and control of hypertension. The odds for hypertension were higher in older adults than that in younger adults especially in females, but younger adults had lower odds in the awareness, treatment, and control of hypertension both in males and females. The results indicate that younger adults are more likely to neglect their own health and have more adverse life habits, which may cause hypertension-related complications and increase the probability of mortality (9). Hypertensive patients aged 35 years and above were included in the National Basic Public Health Service Project, which were provided with free management services by the local primary health care workers, while the younger hypertensive patients lack standardized management and have poor compliance. So popularizing the importance of self-management of hypertension is vitally important to initiating a healthy lifestyle and promote self-examination of hypertension to prevent hypertension from an early age.
Gender differences were also revealed in the prevalence, awareness, treatment, and control of hypertension. Women had a lower prevalence but were more likely to be aware of hypertension, take hypertension treatment, and control their condition when compared to men. Studies have shown that men usually face higher social pressure and have more opportunities to be exposed to risk factors of chronic diseases such as smoke and alcohol. Women have more contact with the health care system and are more likely to seek medical attention if they have an episode of illness.
This study found that income inequality was associated with the awareness, treatment, and control of hypertension. Those with lower annual household income tended to have lower rates of awareness, treatment, and control, which was consistent with findings in some other middle-income countries (10). Psychosocial mechanisms suggest that people with more economic resources may be less likely to feel frustrated or inferior when comparing to those with fewer economic resources (11). They also have more financial resources to cover related medical costs and can get more social support after being diagnosed with hypertension.
This study found an inverse association between smoke and hypertension in males and there was no association between smoke and hypertension in females. This is probably due to reverse causation and the fact that men with hypertension are more likely to be advised by their doctors to quit smoking. Additionally, we found that former male smokers were more aware of their hypertension and had better control than never-smokers. This could be explained by people knowing that they were hypertensive were more likely to quit smoking and paid more attention to their health status (12). This pattern was also found in a study from Canada (13). Other behavioral risk factors such as alcohol consumption, excessive salt intake and lack of physical activity were also related with hypertension. Having a healthy lifestyle is important for preventing hypertension.
This study was subject to a few limitations. First, this was a cross-sectional study, which cannot test causality or rule out reverse causation, particularly for smoking. Second, the awareness and treatment status of hypertension were self-reported, which may incur errors and recall bias.
In conclusion, hypertension prevalence in the labor force population was high in China. Although the rate of awareness, treatment, and control of hypertension has increased markedly, challenges still exist in how to identify hypertensive individuals who are unaware of their hypertension and how to provide primary care. Effective public health strategies targeting at the labor force population, such as older adults, males, overweight and obese participants, are needed for hypertension prevention and management.
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This study was funded by Ministry of Health of the People’s Republic of China. We are grateful to the support from the Chinese Center for Disease Control and Prevention (China CDC), the National Institution for Nutrition and Health, and all related provincial and local health administrative departments, local CDCs and more than 2,000 field interviewers.
FootNote
| ① | CI=Confidence Interval. |
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