Low awareness of hypertension and diabetes among older people in China, a source of public health problems

According to a new study by the Columbia University Mailman School of Public Health, cases of hypertension and diabetes have been poorly sensitized and the treatment involved has been compromised, and increased screening has resulted in no improvement significant. The results are online in the newspaper BMC Public Health.

Until now, there was little information on how people with hypertension or diabetes in China had started to know their health conditions and the factors that had contributed to the changes. awareness over time.

"It does not appear that the screening activities implemented as part of a national health survey have improved the awareness and management of these conditions." The ongoing limited awareness of diabetes and diabetes has not improved. Hypertension remains a major public health problem, "said LH Lumey, MD, professor of epidemiology.

Using data from the Longitudinal Health and Retirement Study in China (CHARLS), researchers measured the impact of a screening program on people aged 45 and over between 2011 and 2015. After 2011 , study participants were interviewed again every two years for changes over time in their health, economic or social conditions. Physical exams were repeated in 2013 and 2015, and participants were asked again if they had ever been diagnosed with hypertension or diabetes. Over 80% of participants surveyed in 2011 continued to participate in 2015.

Of the more than 11,000 people screened in 2011, 49% had high blood pressure and 18% had diabetes through medical exams. More than 80% of middle-aged and elderly Chinese diagnosed with hypertension and / or diabetes in 2011 reported in 2015 not knowing that they had this disease. Conscious hypertensive patients were more likely to be older women, living in urban areas and having a higher BMI.

Hypertension was defined as diastolic blood pressure of 90 mmHg or greater; systolic blood pressure equal to or greater than 140 mmHg; or both; or as currently using an antihypertensive drug. Diabetes was defined as fasting plasma glucose of 126 mg / dL or greater; an HbA1c concentration of 6.5 mg / dL or higher; or a self-report of diabetes diagnosed by a doctor.

There was some improvement in disease awareness between 2011 and 2015, mainly due to a medical examination initiated by the study participants themselves (over 75%), by their work unit or their community (12-15%), but rarely (less than 3%) by CHARLS exam. "One possible explanation is that screening in the health survey was considered simply as an isolated process and not as a monitoring, treatment or referral tool," Lumey said.

Several reasons could explain the limited increase in the reported notoriety of the disease in 2015, according to the researchers. Some participants may not have received the results of the physical examination and blood tests of the 2011 survey; they may not have understood the results; or, they may have forgotten the results. "They may also have refused to acknowledge that they had been diagnosed with diabetes or high blood pressure or had not taken the appropriate steps for managing the disease," Lumey said. "This will require further studies."

"Although we have observed an increase in hypertension and diabetes awareness over time in the CHARLS survey, our results suggest a" failure to act on the results "and raise important questions about effective communication of screening results, not only in CHARLS but health surveys, "noted Chihua Li from Zhengzhou Central Hospital in China.

"Maybe the individuals were supposed to act on their own after receiving the results of the screening," said Lumey. "But our results show that it is important to step up efforts to ensure that participants understand the results of the medical examination and are motivated to have access to appropriate health services in the future." If there is a need to provide systematic feedback of screening results to survey participants and monitor disease awareness over time, it will be essential to improve recognition of the disease and facilitate management. optimal. "