Search

Objective To assess missed opportunities for hypertension screening at health facilities in India and describe systematic differences in these missed opportunities across states and sociodemographic groups. Methods We used nationally representative survey data from the 2017-2018 Longitudinal Ageing Study in India to estimate the proportion of adults aged 45 years or older identified with hypertension and who had not been diagnosed with hypertension despite having visited a health facility during the previous 12 months. We estimated age-sex adjusted proportions of missed opportunities to diagnose hypertension, as well as actual and potential proportions of diagnosis, by sociodemographic characteristics and for each state. Findings Among those identified as having hypertension, 22.6% (95% confidence interval, CI: 21.3 to 23.8) had not been diagnosed despite having recently visited a health facility. If these opportunities had been realized, the prevalence of diagnosed hypertension would have increased from 54.8% (95% CI: 53.5 to 56.1) to 77.3% (95% CI: 76.2 to 78.5). Missed opportunities for diagnosis were more common among individuals who were poorer (P = 0.001), less educated (P < 0.001), male (P < 0.001), rural (P < 0.001), Hindu (P=0.001), living alone (P = 0.028) and working (P < 0.001). Missed opportunities for diagnosis were more common at private than at public health facilities (P < 0.001) and varied widely across states (P < 0.001). Conclusion Opportunistic screening for hypertension has the potential to significantly increase detection of the condition and reduce sociodemographic and geographic inequalities in its diagnosis. Such screening could be a first step towards more effective and equitable hypertension treatment and control. Objectif Evaluer les occasions manquees de depistage de l'hypertension dans les etablissements de sante en Inde et decrire les differences systematiques de ces occasions manquees entre les Etats indiens et les groupes sociodemographiques. Methodes Nous avons utilise les donnees d'enquete representatives au niveau national de l'etude longitudinale sur le vieillissement 2017-2018 en Inde pour estimer la proportion d'adultes ages de 45 ans et plus identifies comme souffrant d'hypertension et qui n'avaient pas ete diagnostiques comme tels malgre une visite dans un etablissement de sante au cours des 12 mois precedents. Nous avons estime les proportions ajustees selon l'age et le sexe des occasions manquees de diagnostic de l'hypertension, ainsi que les proportions reelles et potentielles de diagnostic, selon les caracteristiques sociodemographiques et pour chaque Etat. Resultats Parmi les personnes identifiees comme souffrant d'hypertension, 22,6% (intervalle de confiance (IC) a 95% : 21,3 a 23,8) n'avaient pas ete diagnostiques malgre une visite recente dans un etablissement de sante. Si ces occasions avaient ete concretisees, la prevalence de l'hypertension diagnostiquee serait passee de 54,8% (IC a 95% : 53,5 a 56,1) a 77,3% (IC a 95% : 76,2 a 78,5). Les occasions manquees de diagnostic etaient plus frequentes chez les personnes plus pauvres (P = 0,001), moins instruites (P < 0,001), de sexe masculin (P < 0,001), habitant en zone rurale (P < 0,001), hindoues (P = 0,001), vivant seules (P = 0,028) et travaillant (P < 0,001). Les occasions manquees de diagnostic etaient plus frequentes dans les etablissements de sante prives que dans les etablissements publics (P < 0,001) et variaient considerablement d'un Etat a l'autre (P < 0,001). Conclusion Le depistage opportuniste de l'hypertension a le potentiel d'augmenter significativement la detection de cette affection et de reduire les inegalites sociodemographiques et geographiques dans son diagnostic. Ce depistage pourrait etre une premiere etape vers un traitement et une prise en charge plus efficaces et equitables de l'hypertension. Objetivo Evaluar las oportunidades perdidas para el cribado de la hipertension en los centros sanitarios de la India y describir las diferencias sistematicas en estas oportunidades perdidas entre estados y grupos sociodemograficos. Metodos Se utilizaron datos de encuestas representativas a nivel nacional del Estudio Longitudinal del Envejecimiento 2017-2018 en la India para estimar el porcentaje de adultos de 45 anos o mas que fueron identificados con hipertension y que no habian sido diagnosticados con hipertension a pesar de haber visitado un centro sanitario durante los 12 meses anteriores. Se calcularon los porcentajes ajustados por edad y sexo de las oportunidades perdidas para diagnosticar la hipertension, asi como los porcentajes reales y potenciales de diagnostico, por caracteristicas sociodemograficas y para cada estado. Resultados Entre las personas identificadas como hipertensas, el 22,6 % (intervalo de confianza del 95 %, IC: 21,3 a 23,8) no habian sido diagnosticadas a pesar de haber acudido a un centro sanitario recientemente. Si se hubieran aprovechado estas oportunidades, la prevalencia de hipertension diagnosticada habria aumentado del 54,8 % (IC del 95 %: 53,5 a 56,1) al 77,3 % (IC del 95 %: 76,2 a 78,5). Las oportunidades perdidas para el diagnostico fueron mas comunes entre las personas mas pobres (P = 0,001), con menos educacion (P < 0,001), varones (P < 0,001), de zonas rurales (P < 0,001), hindues (P = 0,001), que viven solas (P = 0,028) y que trabajan (P < 0,001). Las oportunidades perdidas para el diagnostico fueron mas comunes en los centros sanitarios privados que en los publicos (P < 0,001) y variaron en gran medida entre los estados (P < 0,001). Conclusion El cribado oportuno de la hipertension tiene el potencial de aumentar de manera significativa la deteccion de la enfermedad y de disminuir las desigualdades sociodemograficas y geograficas en su diagnostico. Este cribado podria ser un primer paso hacia un tratamiento y control de la hipertension mas eficaz y equitativo. [phrase omitted], Introduction Hypertension that is undiagnosed, and so goes untreated and uncontrolled, raises the risks of cardiovascular diseases and premature death. (1-3) Failure to prevent ill-health and medical treatments arising from [...]

Background Lack of nationwide evidence on awareness, treatment, and control (ATC) of hypertension among older adults in India impeded targeted management of this condition. We aimed to estimate rates of hypertension ATC in the older population and to assess differences in these rates across sociodemographic groups and states in India. Methods and findings We used a nationally representative survey of individuals aged 45 years and over and their spouses in all Indian states (except one) in 2017 to 2018. We identified hypertension by blood pressure (BP) measurement [greater than or equal to]140/90 mm Hg or self-reported diagnosis if also taking medication or observing salt/diet restriction to control BP. We distinguished those who (i) reported diagnosis ('aware'); (ii) reported taking medication or being under salt/diet restriction to control BP ('treated'); and (iii) had measured systolic BP The 64,427 participants in the analysis sample had a median age of 57 years: 58% were female, and 70% were rural dwellers. We estimated hypertension prevalence to be 41.9% (95% CI 41.0 to 42.9). Among those with hypertension, we estimated that 54.4% (95% CI 53.1 to 55.7), 50.8% (95% CI 49.5 to 52.0), and 28.8% (95% CI 27.4 to 30.1) were aware, treated, and controlled, respectively. Across states, adjusted rates of ATC ranged from 27.5% (95% CI 22.2 to 32.8) to 75.9% (95% CI 70.8 to 81.1), from 23.8% (95% CI 17.6 to 30.1) to 74.9% (95% CI 69.8 to 79.9), and from 4.6% (95% CI 1.1 to 8.1) to 41.9% (95% CI 36.8 to 46.9), respectively. Age-sex adjusted rates were lower (p < 0.001) in poorer, less educated, and socially disadvantaged groups, as well as for males, rural residents, and the employed. Among individuals with hypertension, the richest fifth were 8.5 percentage points (pp) (95% CI 5.3 to 11.7; p < 0.001), 8.9 pp (95% CI 5.7 to 12.0; p < 0.001), and 7.1 pp (95% CI 4.2 to 10.1; p < 0.001) more likely to be aware, treated, and controlled, respectively, than the poorest fifth. Conclusions Hypertension prevalence was high, and ATC of the condition were low among older adults in India. Inequalities in these indicators pointed to opportunities to target hypertension management more effectively and equitably on socially disadvantaged groups., Author(s): Sanjay K. Mohanty 1,*, Sarang P. Pedgaonkar 2, Ashish Kumar Upadhyay 3, Fabrice Kämpfen 4, Prashant Shekhar 3, Radhe Shyam Mishra 3, Jürgen Maurer 5, Owen O'Donnell 6 Introduction [...]

We propose tests of the two assumptions under which anchoring vignettes identify heterogeneity in reporting of categorical evaluations. Systematic variation in the perceived difference between any two vignette states is sufficient to reject "vignette equivalence." "Response consistency"--the respondent uses the same response scale to evaluate the vignette and herself--is testable given sufficiently comprehensive objective indicators that independently identify response scales. Both assumptions are rejected for reporting of cognitive and physical functioning in a sample of older English individuals, although a weaker test resting on less stringent assumptions does not reject "response consistency" for cognition. (Contains 2 figures, 7 tables, and 9 footnotes.)

While there is no doubt that health is strongly correlated with education, whether schooling exerts a causal impact on health is not firmly established. We exploit a Dutch compulsory schooling law to estimate the causal effect of education on mortality. The reform provides a powerful instrument, significantly raising years of schooling, which, in turn, has a significant and robust negative effect on mortality. For men surviving to age 81, an extra year of schooling is estimated to reduce the probability of dying before the age of 89 by almost three percentage points relative to a baseline of 50 percent. (Contains 24 footnotes, 6 tables, and 6 figures.)