Health systems performance for hypertension control using a cascade of care approach in South Africa, 2011-2017.

Autor:	Benade M; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.; Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa., Mchiza Z; Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.; School of Public Health, University of the Western Cape, Bellville, South Africa., Raquib RV; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America., Prasad SK; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America., Yan LD; Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America., Brennan AT; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.; Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa.; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America., Davies J; Department of Global Health, University of Birmingham, Birmingham, United Kingdom., Sudharsanan N; Heidelberg Institute for Global Health, Heidelberg University, Heidelberg, Germany., Manne-Goehler J; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America., Fox MP; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.; Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa.; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America., Bor J; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.; Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa.; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America., Rosen SB; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.; Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa., Stokes AC; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.
Jazyk:	angličtina
Zdroj:	PLOS global public health [PLOS Glob Public Health] 2023 Sep 07; Vol. 3 (9), pp. e0002055. Date of Electronic Publication: 2023 Sep 07 (Print Publication: 2023).
DOI:	10.1371/journal.pgph.0002055
Abstrakt:	Hypertension is a major contributor to global morbidity and mortality. In South Africa, the government has employed a whole systems approach to address the growing burden of non-communicable diseases. We used a novel incident care cascade approach to measure changes in the South African health system's ability to manage hypertension between 2011 and 2017. We used data from Waves 1-5 of the National Income Dynamics Study (NIDS) to estimate trends in the hypertension care cascade and unmet treatment need across four successive cohorts with incident hypertension. We used a negative binomial regression to identify factors that may predict higher rates of hypertension control, controlling for socio-demographic and healthcare factors. In 2011, 19.6% (95%CI 14.2, 26.2) of individuals with incident hypertension were diagnosed, 15.4% (95%CI 10.8, 21.4) were on treatment and 7.1% had controlled blood pressure. By 2017, the proportion of individuals with diagnosed incident hypertension had increased to 24.4% (95%CI 15.9, 35.4). Increases in treatment (23.3%, 95%CI 15.0, 34.3) and control (22.1%, 95%CI 14.1, 33.0) were also observed, translating to a decrease in unmet need for hypertension care from 92.9% in 2011 to 77.9% in 2017. Multivariable regression showed that participants with incident hypertension in 2017 were 3.01 (95%CI 1.77, 5.13) times more likely to have a controlled blood pressure compared to those in 2011. Our data show that while substantial improvements in the hypertension care cascade occurred between 2011 and 2017, a large burden of unmet need remains. The greatest losses in the incident hypertension care cascades came before diagnosis. Nevertheless, whole system programming will be needed to sufficiently address significant morbidity and mortality related to having an elevated blood pressure. Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests:Dr Stokes reported receiving grants from Swiss Re and Johnson & Johnson outside the submitted work. No other disclosures were reported. (Copyright: © 2023 Benade et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze:	MEDLINE
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