Graphical abstract:
National trends and factors associated with ischemic heart disease among individuals with hypertension in Thailand from 2011 to 2018.
Table 1
Characteristics of study participants (2011–2015 and 2018).
| CYCLE YEAR | 2011 | 2012 | 2013 | 2014 | 2015 | 2018 |
|---|---|---|---|---|---|---|
| CHARACTERISTICS | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) |
| Sample size | 42,652 | 41,268 | 40,839 | 33,227 | 32,302 | 36,132 |
| Sex | ||||||
| Men | 14,987 (35.1) | 14,977 (36.3) | 14,990 (36.7) | 12,400 (37.3) | 12,387 (38.4) | 13,920 (38.5) |
| Women | 276,65 (64.9) | 26,291 (63.7) | 26,349 (64.5) | 20,827 (62.7) | 19,915 (61.7) | 22,212 (61.5) |
| Age (years) | ||||||
| 20–29 | 53 (0.1) | 56 (0.1) | N/A | 51 (0.2) | 51 (0.2) | 67 (0.2) |
| 30–39 | 797 (1.9) | 697 (1.7) | 546 (1.3) | 524 (1.6) | 548 (1.7) | 536 (1.5) |
| 40–49 | 4,766 (11.2) | 4,372 (10.6) | 4,278 (10.5) | 3,259 (9.8) | 3,096 (9.6) | 3,079 (8.5) |
| 50–59 | 11,758 (27.6) | 11,240 (27.2) | 10,744 (26.3) | 8,259 (24.9) | 7,970 (24.7) | 8,441 (23.4) |
| 60–69 | 13,097 (30.7) | 12,829 (31.1) | 12,791 (31.3) | 10,128 (30.5) | 9,866 (30.5) | 11,468 (31.7) |
| 70–79 | 9,496 (22.3) | 9,319 (22.6) | 9,405 (23.0) | 7,886 (23.7) | 7,609 (23.6) | 8,463 (23.4) |
| ≥80 | 2,685 (6.3) | 2,755 (6.7) | 3,075 (7.5) | 3,120 (9.4) | 3,162 (9.8) | 4,078 (11.3) |
| Mean (SD) | 62.4 (11.3) | 62.7 (11.3) | 63.2 (11.1) | 63.8 (11.7) | 63.9 (11.8) | 64.7 (11.9) |
| Geographical region | ||||||
| North | 11,160 (26.2) | 10,857 (26.3) | 10,734 (26.3) | 9,834 (29.6) | 8,135 (25.2) | 8,090 (22.4) |
| Central | 14,158 (33.2) | 12,677 (30.7) | 13,574 (33.2) | 11,351 (34.2) | 11,701 (36.2) | 11,869 (32.9) |
| Northeast | 10,954 (25.7) | 11,572 (28.0) | 10,278 (25.2) | 7,387 (22.2) | 7,461 (23.1) | 9,970 (27.6) |
| South | 6,380 (15.0) | 6,162 (14.9) | 6,253 (15.3) | 4,655 (14.0) | 5,005 (15.5) | 6,203 (17.2) |
| Occupation | ||||||
| Agricultural worker | 17,260 (40.5) | 16,054 (38.9) | 14,817 (36.3) | 11,540 (34.7) | 11,086 (34.3) | 12,068 (33.4) |
| Employee | 6,778 (15.9) | 7,421 (18.0) | 7,688 (18.8) | 5,265 (15.9) | 5,037 (15.6) | 5,265 (14.6) |
| Government officer | 1,838 (4.3) | 1,728 (4.2) | 1,543 (3.8) | 1,535 (4.6) | 1,814 (5.6) | 2,010 (5.6) |
| Private officer | 222 (0.5) | 165 (0.4) | 378 (0.9) | 268 (0.8) | 338 (1.1) | 307 (0.9) |
| Business owner | 2,775 (6.5) | 2,497 (6.1) | 2,478 (6.1) | 1,486 (4.5) | 1,754 (5.4) | 1,789 (5.0) |
| Priest | 164 (0.4) | 156 (0.4) | 170 (0.4) | 139 (0.4) | 152 (0.5) | 201 (0.6) |
| No occupation | 13,320 (31.2) | 11,651 (28.2) | 12,123 (29.7) | 11,501 (34.6) | 10,963 (33.9) | 13,513 (37.4) |
| Others | 295 (0.7) | 1,596 (3.9) | 1,642 (4.0) | 1,493 (4.5) | 1,158 (3.6) | 979 (2.7) |
| Outpatient-clinic location | ||||||
| Community hospital | 27,365 (64.2) | 26,944 (65.3) | 24,136 (59.1) | 24,355 (73.3) | 21,085 (65.3) | 25,205 (69.8) |
| General hospital | 8,118 (19.0) | 7,933 (19.2) | 8,866 (21.7) | 5,020 (15.1) | 5,525 (17.1) | 5,877 (16.3) |
| Regional hospital | 5,252 (12.3) | 4,787 (11.6) | 5,811 (14.2) | 2,352 (7.1) | 2,738 (8.5) | 2,463 (6.8) |
| Others | 1,917 (4.5) | 1,604 (3.9) | 2,026 (5.0) | 1,500 (4.5) | 2,954 (9.1) | 2,587 (7.2) |
| Health insurance scheme | ||||||
| Universal health coverage | 32,278 (75.7) | 30,724 (74.5) | 30,645 (75.0) | 24,892 (74.9) | 23,480 (72.7) | 26,855 (74.3) |
| Civil servant medical benefits | 8,641 (20.3) | 8,565 (20.8) | 8,164 (20.0) | 6,594 (19.9) | 6,963 (21.6) | 7,528 (20.8) |
| Social security | 1,476 (3.5) | 1,535 (3.7) | 1,709 (4.2) | 1,399 (4.2) | 1,529 (4.7) | 1,583 (4.4) |
| Others | 257 (0.6) | 444 (1.1) | 321 (0.8) | 342 (1.0) | 330 (1.0) | 166 (0.5) |
| Duration of hypertension treatment (years) | ||||||
| Mean (SD) | 5.4 (3.6) | 6.2 (2.1) | 5.9 (3.9) | 6.3 (4.0) | 5.5 (3.8) | 6.7 (4.5) |
[i] Abbreviation: SD, standard deviation.
Table 2
Trends in prevalence of ischemic heart disease by demographic characteristics among individuals with hypertension in Thailand (2011–2015 and 2018).
| PREVALENCE PER 1,000 INDIVIDUALS (95% CI) | p-TREND | ABSOLUTE PREVALENCE CHANGE, 2015–2018a | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| CYCLE YEAR | OVERALL | 2011 | 2012 | 2013 | 2014 | 2015 | 2018 | ∆ PER 1,000 (95% CI) | p-VALUE | |
| Sample size | 42,652 | 41,268 | 40,839 | 33,227 | 32,302 | 36,132 | ||||
| Totalb | 226,420 | 56.6 (49.7–64.5) | 49.3 (42.2–57.6) | 48.4(42.3–56.6) | 48.2 (42.0–55.2) | 45.4 (39.7–52.0) | 34.5 (30.1–39.6) | <0.001 | –10.9 (–15.4 to –5.7) | <0.001 |
| Sexc | ||||||||||
| Women | 142,759 | 47.0 (40.3–54.7) | 40.8 (34.7–47.9) | 39.4 (33.2–46.8) | 40.2 (34–47.4) | 38.0 (32.1–45) | 28.6 (24.6–33.4) | <0.001 | –9.3 (–12.8 to –5.9) | <0.001 |
| Men | 83,661 | 72.2 (63.8–81.6) | 63.0 (52.0–76.1) | 64.2 (55.1–74.7) | 61.0 (53.2–70) | 57.4 (50.3–65.5) | 44.0 (37.8–51.2) | <0.001 | –13.4 (–18.7 to –8.1) | <0.001 |
| Age (years)d | ||||||||||
| 20–49 | 26,776 | 24.2 (19.8–29.6) | 16.3 (12.0–22.0) | 23.2 (18.7–28.7) | 16.7 (11.8–23.8) | 16.5 (11.6–23.4) | 9.2 (6.1–13.8) | 0.001 | –7.4 (–12.5 to –2.2) | 0.005 |
| 50–59 | 58,412 | 35.8 (30.6–41.9) | 32.2 (26.4–39.3) | 29.7 (24.6–35.8) | 25.7 (21.7–30.3) | 25.8 (19.9–33.4) | 18.9 (15.4–23.2) | <0.001 | –6.9 (–11.4 to –2.3) | 0.003 |
| 60–69 | 70,179 | 56.7 (50.2–64.0) | 46.8 (42.0–52.2) | 47.1 (39.5–56.0) | 47.4 (40.1–55.9) | 46.3 (40.0–53.6) | 31.3 (27.0–36.3) | <0.001 | –15.0 (–20.2 to –9.7) | <0.001 |
| 70–79 | 52,178 | 77.8 (66.2–91.4) | 73.6 (61.8–87.4) | 68.4 (57.4–81.5) | 69.2 (59.4–80.4) | 65.5 (54.6–78.4) | 53.9 (46.8–62.1) | <0.001 | –11.6 (–18.9 to –4.2) | 0.019 |
| ≥80 | 18,875 | 95.7 (81.0–112.8) | 80.6 (61.9–104.4) | 86.8 (69.9–107.2) | 93.6 (80.1–109.1) | 77.7 (66.1–91.2) | 66.8 (53.6–83.2) | 0.001 | –10.9 (–23.0 to 1.2) | 0.750 |
| Geographical regionb | ||||||||||
| North | 58,810 | 58.4 (43.2–78.4) | 45.2 (31.3–64.9) | 46.0 (31.0–67.9) | 48.2 (33.2–69.4) | 47.7 (35.0–64.7) | 37.8 (24.6–57.6) | 0.354 | –9.9 (–16.2 to –3.7) | 0.002 |
| Central | 75,330 | 70.3 (55.1–89.3) | 61.0 (47.3–78.3) | 60.0 (46.1–77.7) | 56.0 (44.3–70.6) | 53.6 (40.5–70.7) | 36.5 (29.1–45.8) | <0.001 | –17.1 (–22.4 to –11.8) | <0.001 |
| Northeast | 57,622 | 37.4 (32.0–43.7) | 47.6 (37.0–61.1) | 41.9 (31.5–55.4) | 40.9 (35.9–46.5) | 31.5 (26.3–37.6) | 25.6 (21.3–30.6) | <0.001 | –5.9 (–10.9 to –0.9) | 0.020 |
| South | 34,658 | 49.9 (44.5–56.0) | 42.0 (29.8–58.8) | 48.2 (37.6–61.7) | 52.8 (42.9–64.9) | 52.5 (39.7–69) | 44.8 (35.6–56.3) | 0.520 | –7.6 (–15.7 to 0.4) | 0.061 |
[i] Abbreviation: CI, confidence interval.
aAbsolute prevalence change = prevalence 2018 – prevalence 2015. p-Value for null hypothesis: absolute % change = 0.
bEstimates are directly standardized to the age and sex distribution of the 2015 study population.
cEstimates are directly standardized to the age distribution of the 2015 study population.
dEstimates are directly standardized to the sex distribution of the 2015 study population.
Figure 1
Trends in prevalence of ischemic heart disease (IHD) among individuals with hypertension in Thailand (2011–2015 and 2018). Abbreviation: CI, confidence interval.
†Age- and sex- adjusted for study population in 2015, ‡Sex-specific, age adjusted for study population in 2015, *IHD: Ischemic Heart Disease, CI: confidence interval.
Table 3
Trends in incidence of ischemic heart disease by demographic characteristics among individuals with hypertension in Thailand (2011–2015 and 2018).
| ONE-YEAR PERIOD INCIDENCE PER 1,000 INDIVIDUALS (95% CI) | p-TREND | ABSOLUTE INCIDENCE CHANGE, 2015–2018a | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| CYCLE YEAR | OVERALL | 2011 | 2012 | 2013 | 2014 | 2015 | 2018 | ∆ PER 1,000 (95% CI) | p-VALUE | |
| Sample size | 40,767 | 39,488 | 39,106 | 31,710 | 30,975 | 34,965 | ||||
| Totalb | 217,011 | 9.8 (7.7–12.3) | 5.9 (4.5–7.8) | 6.1 (4.9–7.5) | 8.4 (6.6–10.6) | 7.9 (6.2–9.9) | 4.0 (3.1–5.2) | <0.001 | –3.8 (–5.0 to –2.6) | <0.001 |
| Sexc | ||||||||||
| Women | 137,808 | 8.1 (6.4–10.2) | 5.4 (4.1–7.2) | 4.3 (3.2–5.9) | 7.2 (5.3–9.9) | 6.4 (4.9–8.3) | 3.8 (2.8–5.3) | 0.008 | –2.6 (–4.0 to –1.2) | <0.001 |
| Men | 79,203 | 12.4 (9.4–16.5) | 6.8 (4.9–9.4) | 8.9 (7.3–10.8) | 10.2 (8.3–12.4) | 10.2 (8.0–13.1) | 4.3 (3.1–6.0) | 0.002 | –5.9 (–8.0 to –3.8) | <0.001 |
| Age (years)d | ||||||||||
| 20–49 | 26,413 | 6.6 (4.0–11.1) | 2.6 (1.4–5.0) | 5.6 (3.8–8.3) | 4.0 (2.1–7.6) | 5.1 (2.1–12.4) | 2.2 (1.1–4.6) | 0.149 | –2.9 (–5.6 to –0.1) | 0.043 |
| 50–59 | 56,967 | 6.4 (4.7–8.7) | 3.6 (2.2–6.0) | 3.9 (2.6–5.8) | 4.0 (2.5–6.3) | 5.0 (3.2–7.8) | 2.4 (1.2–5.0) | 0.033 | –2.6 (–4.5 to –0.7) | 0.006 |
| 60–69 | 67,301 | 10.2 (8.0–12.9) | 6.4 (4.2–9.6) | 5.6 (4.0–7.8) | 10.0 (6.6–15.3) | 8.5 (5.8–12.3) | 2.8 (1.7–4.5) | <0.001 | –5.7 (–7.8 to –3.6) | <0.001 |
| 70–79 | 48,901 | 13.2 (10.5–16.8) | 9.4 (5.5–15.8) | 8.5 (6.0–12.1) | 9.9 (6.9–14.3) | 9.2 (6.4–13.3) | 7.1 (5.0–9.9) | 0.012 | –2.1 (–5.0 to 0.7) | 0.143 |
| ≥80 | 17,429 | 12.7 (8.5–19.1) | 6.4 (3.7–11.2) | 8.0 (5.2–12.3) | 16.3 (12.2–21.6) | 13.6 (9.1–20.4) | 7.2 (4.5–11.4) | 0.219 | –6.5 (–11.5 to –1.5) | 0.008 |
| Geographical regionb | ||||||||||
| North | 56,255 | 9.1 (6.2–13.3) | 4.4 (2.2–8.5) | 4.4 (3.2–5.9) | 5.9 (3.6–9.7) | 5.9 (3.7–9.6) | 3.4 (2.1–5.5) | 0.080 | –2.5 (–4.7 to –0.4) | 0.021 |
| Central | 71,601 | 14.3 (11.4–17.9) | 8.4 (6.3–11.3) | 9.8 (7.7–12.6) | 7.7 (5.6–10.6) | 7.2 (5.1–10.2) | 3.8 (2.1–6.7) | <0.001 | –3.5 (–5.4 to –1.6) | <0.001 |
| Northeast | 55,974 | 5.1 (3.6–7.3) | 6.0 (4.7–7.6) | 4.1 (3.1–5.4) | 10.5 (8.7–12.7) | 7.5 (4.7–11.7) | 3.7 (2.3–6.0) | 0.057 | –3.7 (–6.1 to –1.4) | 0.001 |
| South | 33,181 | 6.8 (4.5–10.5) | 4.8 (2.4–9.8) | 6.0 (2.8–12.5) | 9.7 (5.8–16.1) | 12.2 (7.5–19.8) | 6.5 (4.3–9.7) | 0.882 | –5.7 (–9.4 to –2.0) | 0.002 |
[i] Abbreviation: CI, confidence interval.
aAbsolute incidence change = incidence 2018 – incidence 2015. p-Value for null hypothesis: absolute incidence change = 0.
bEstimates are directly standardized to the age and sex distribution of the 2015 study population.
cEstimates are directly standardized to the age distribution of the 2015 study population.
dEstimates are directly standardized to the sex distribution of the 2015 study population.
Figure 2
Trends in incidence of ischemic heart disease (IHD) among individuals with hypertension in Thailand (2011–2015 and 2018). Abbreviation: CI, confidence interval.
†Age- and sex- adjusted for study population in 2015, ‡Sex-specific, age adjusted for study population in 2015, *IHD: Ischemic Heart Disease, CI: confidence interval.
Table 4
Factors associated with ischemic heart disease incidence among individuals with hypertension in Thailand.
| CHARACTERISTICS | TOTAL | IHD INCIDENCE | UNIVARIABLE ANALYSISa | MULTIVARIABLE ANALYSISa* | ||
|---|---|---|---|---|---|---|
| N | n (%) | CRR (95% CI) | p-VALUE | ARR (95% CI) | p-VALUE | |
| Cycle year | ||||||
| 2011 | 40,767 | 353 (0.87) | Ref. | Ref. | ||
| 2012 | 39,488 | 252 (0.64) | 0.74 (0.62–0.87) | <0.001 | 0.80 (0.65–0.98) | 0.032 |
| 2013 | 39,106 | 247 (0.64) | 0.73 (0.60–0.89) | 0.002 | 0.74 (0.59–0.93) | 0.011 |
| 2014 | 31,710 | 266 (0.85) | 0.97 (0.78–1.20) | 0.770 | 0.94 (0.74–1.19) | 0.598 |
| 2015 | 30,975 | 218 (0.71) | 0.81 (0.64–1.04) | 0.098 | 0.76 (0.58–1.00) | 0.050 |
| 2018 | 34,965 | 148 (0.43) | 0.49 (0.36–0.66) | <0.001 | 0.45 (0.33–0.62) | <0.001 |
| Sex | ||||||
| Women | 137,808 | 805 (0.59) | Ref. | Ref. | ||
| Men | 79,203 | 679 (0.86) | 1.47 (1.30–1.66) | <0.001 | 1.32 (1.12–1.56) | 0.001 |
| Age (years) | ||||||
| <50 | 26,413 | 104 (0.40) | Ref. | Ref. | ||
| 50–59 | 56,967 | 254 (0.45) | 1.13 (0.88–1.45) | 0.331 | 1.12 (0.87–1.46) | 0.382 |
| 60–69 | 67,301 | 478 (0.72) | 1.80 (1.42–2.30) | <0.001 | 1.73 (1.35–2.22) | <0.001 |
| 70–79 | 48,901 | 457 (0.94) | 2.37 (1.79–3.14) | <0.001 | 2.26 (1.67–3.05) | <0.001 |
| ≥80 | 17,429 | 191 (1.11) | 2.78 (2.12–3.65) | <0.001 | 2.57 (1.92–3.44) | <0.001 |
| Geographical region | ||||||
| Northeast | 55,974 | 299 (0.54) | Ref. | Ref. | ||
| North | 56,255 | 331 (0.59) | 1.10 (0.84–1.44) | 0.483 | 1.04 (0.80–1.36) | 0.772 |
| Central | 71,601 | 601 (0.85) | 1.57 (1.24–1.99) | <0.001 | 1.49 (1.13–1.96) | 0.004 |
| South | 33,181 | 253 (0.77) | 1.43 (1.03–1.97) | 0.032 | 1.48 (1.04–2.10) | 0.031 |
| Occupation | ||||||
| Agricultural worker | 79,979 | 457 (0.57) | Ref. | Ref. | ||
| Employee | 36,126 | 262 (0.73) | 1.27 (1.04–1.55) | 0.019 | 1.13 (0.92–1.39) | 0.242 |
| Government officer | 10,217 | 50 (0.49) | 0.86 (0.60–1.22) | 0.393 | 0.96 (0.64–1.45) | 0.858 |
| Private officer | 1,653 | 9 (0.55) | 0.95 (0.33–2.74) | 0.929 | 0.96 (0.42–2.21) | 0.922 |
| Business owner | 12,298 | 69 (0.56) | 0.98 (0.77–1.25) | 0.880 | 0.89 (0.70–1.13) | 0.342 |
| Priest | 887 | 20 (2.31) | 3.95 (2.43–6.41) | <0.001 | 2.45 (1.46–4.10) | 0.001 |
| No occupation | 69,040 | 565 (0.83) | 1.43 (1.20–1.71) | <0.001 | 0.99 (0.80–1.22) | 0.925 |
| Others | 6,811 | 52 (0.77) | 1.34 (0.96–1.86) | 0.088 | 1.15 (0.69–1.90) | 0.596 |
| Outpatient-clinic location | ||||||
| Community hospital | 143,755 | 827 (0.58) | Ref. | Ref. | ||
| General hospital | 38,856 | 385 (1.00) | 1.72 (1.35–2.20) | <0.001 | 1.65 (1.25–2.18) | <0.001 |
| Regional hospital | 22,165 | 181 (0.82) | 1.42 (1.05–1.93) | 0.025 | 1.40 (1.01–1.95) | 0.044 |
| Others | 12,235 | 91 (0.75) | 1.29 (1.06–1.57) | 0.010 | 1.11 (0.88–1.39) | 0.365 |
| Health insurance scheme | ||||||
| Universal health coverage | 161,709 | 1,146 (0.71) | Ref. | Ref. | ||
| Civil servant medical benefits | 44,490 | 278 (0.63) | 0.88 (0.77–1.01) | 0.077 | 0.76 (0.64–0.90) | 0.002 |
| Social security | 9,021 | 51 (0.57) | 0.80 (0.56–1.15) | 0.221 | 0.84 (0.59–1.19) | 0.322 |
| Others | 1,761 | 9 (0.51) | 0.72 (0.39–1.35) | 0.304 | 0.72 (0.37–1.43) | 0.354 |
| Diabetes | ||||||
| No | 179,220 | 1,170 (0.66) | Ref. | Ref. | ||
| Yes | 37,791 | 314 (0.84) | 1.27 (1.07–1.52) | 0.007 | 1.20 (1.01–1.43) | 0.045 |
| Dyslipidemia | ||||||
| No | 38,822 | 303 (0.79) | Ref. | Ref. | ||
| Yes | 178,189 | 1,181 (0.67) | 0.85 (0.73–0.99) | 0.034 | 1.00 (0.85–1.17) | 0.974 |
| Chronic kidney disease | ||||||
| No | 201,771 | 1,044 (0.60) | Ref. | Ref. | ||
| Yes | 24,649 | 440 (1.04) | 1.72 (1.49–1.99) | <0.001 | 1.52 (1.30–1.79) | <0.001 |
| Smoking status | ||||||
| Never | 164,188 | 1,008 (0.62) | Ref. | Ref. | ||
| Former smoker | 20,025 | 187 (0.94) | 1.52 (1.26–1.83) | <0.001 | 1.28 (1.04–1.58) | 0.021 |
| Current smoker | 9,365 | 78 (0.84) | 1.36 (1.07–1.72) | 0.011 | 1.23 (0.98–1.54) | 0.076 |
| Duration of hypertension treatment (years) | ||||||
| 1–5 | 98,672 | 658 (0.67) | Ref. | Ref. | ||
| 6–9 | 88,278 | 574 (0.65) | 0.98 (0.85–1.12) | 0.718 | 0.95 (0.81–1.10) | 0.491 |
| 10 and over | 30,061 | 252 (0.85) | 1.26 (1.08–1.47) | 0.004 | 1.13 (0.93–1.36) | 0.218 |
[i] Abbreviations: aRR: adjusted risk ratio; CI, confidence interval; cRR, crude risk ratio; IHD, ischemic heart disease.
aModified Poisson regression with a log link and robust standard errors clustered by province.
*Multivariable analysis adjusted for year, sex, region, occupation, outpatient-clinic location, health insurance scheme, diabetes, dyslipidemia, chronic kidney disease, smoking status, and hypertension duration.
Figure 3
(a) Association between age and ischemic heart disease (IHD) incidence among individuals with hypertension in Thailand, stratified by sex. (b) Association between sex and IHD incidence among individuals with hypertension in Thailand, stratified by age group. Abbreviation: CI, confidence interval.