Table 1
Operationalization of the bars of the Cascade per country.
| BAR | BELGIUM | SLOVENIA | CAMBODIA | NOTES |
|---|---|---|---|---|
| Prevalence | based on survey measuring SBP ≥140 mmHg OR a DBP ≥ 90 mmHa OR self-reported use of antihypertensive medication during the past two weeks OR self-reported diagnosis | no correct estimation possible of the number of people with ‘undiagnosed HTN’ and thus not of the ‘prevalence’ | based on a survey measuring SBP ≥ 140 mmHg OR DBP ≥ 90 mmHg OR self-reported diagnosis as having been told by healthcare professionals that they have HTN | Denominator: total population aged 40–79 |
| Tested | reported that they had a BP measurement in the last 3 years | BP measure by registered nurse in the last 3 years | reported that they had a BP measurement in the last 3 years | |
| 1. Diagnosed | reported that they have the condition ‘HTN’ | registered as ‘having the diagnosis HTN’ | reported that they were diagnosed with HTN by a healthcare professional | the cascade will start from the ‘diagnosed’ bar, with diagnosed as ‘100%’ |
| 2. In care | followed by a healthcare professional for HTN during the past 12 months | HTN consult. in the past 12 months | get treatment/care for HTN in the past 12 months | |
| 3. In treatment | either self-reported use of medication or following a diet to treat HTN during the past 12 months | at least one BP measure in the last 12 months | currently receiving treatment/advice for HTN prescribed by a doctor or other HC worker: Drugs (2w) /diet advice (reduce salt/lose weight/physical exercise.) | in SL there is no information available about HTN medication or non-medical treatment; because BP measure is part of the treatment protocol of HTN, this indicator is used as a proxy of treatment |
| 4. Adhered to treatment (medication adherence) | took prescribed HTN medication last 24h (‘yes’) AND regularly (‘yes’) | adherence assessment HTN: regularly (‘yes’) AND properly (‘yes’) | MARS-5 adherence scale for HTN medication: high adherence (vs. no)b | only among patients who took HTN medication |
| 5. Under control | having SBP <140 mmHg and DBP <90 mmHg | having SBP <140 mmHg and DBP <90 mmHg | having SBP <140 mmHg and DBP <90 mmHg |
[i] Notes: aBP was measured by trained nurses during a home visit as part of the BHES fieldwork. Respondent’s SBP and DBP were determined by taking the respective averages of the last two out of three BP measurement [38]. b Participants indicate how often they engage in each of five HTN medication-adherent behaviours (e.g. “I take less than instructed”) on a 1–5 likert scale (always to never). The item scores are summed to indicate overall level of adherence. Consistent with previous research [4041], MARS scores were then dichotomised to give low adherence (LAd, MARS score ≤21) and high adherence sub-groups (HAd, MARS score N21).
Figure 1
ICP grid scores per country.
Notes: E1:Identification, E2:Treatment, E3:Health education, E4:Self-management support, E5:Structured collaboration, E6:Organization of care; the medium scores are presented; see S6.a-c for the corresponding data. The elements are based on several items and operationalized as scales ranging from 0 (no implementation) to 5 (complete implementation). FFS = fee-for-service; OD = operational district; corresponding numbers in table S4.a-c.
Table 2
The prevalence of HTN, the percentage of people tested and diagnosed with HTN among those aged 40–79 years.
| AMONG INDIVIDUALS AGED 40–79 | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PREVALENCE (%) | TESTED (%) | DIAGNOSED (%) | |||||||||||||||
| MEN | WOMEN | MEN | WOMEN | MEN | WOMEN | ||||||||||||
| % | % ASR | % | % ASR | SIG.b | % | % ASR | % | % ASR | SIG. | % | % ASR | % | % ASR | SIG. | |||
| BE | 44.24 | 41.79 | 40.97 | 35.94 | n.s. | 93.03 | 92.51 | 94.27 | 93.66 | n.s. | 24.4 | 22.98 | 24.87 | 21.43 | n.s. | ||
| SL | n.a.a | n.a.a | 23.40 | 23.04 | 11.49 | 11.76 | <0.001 | 15.65 | 13.99 | 9.97 | 8.07 | ||||||
| CA | 31.41 | 30.79 | 35.13 | 32.51 | n.s. | 48.73 | 48.16 | 67.29 | 66.35 | <0.001 | 13.48 | 12.67 | 26.4 | 23.91 | |||
| AMONG INDIVIDUALS WITH HTN AGED 40–79 | |||||||||||||||||
| BE | 95.73 | 96.58 | 97.03 | 94.62 | n.s. | 42.1 | 42.45 | 53.02 | 49.32 | n.s. | |||||||
| SL | n.a.a | n.a.a | n.a.a | n.a.a | |||||||||||||
| CA | 68.13 | 64.54 | 87.76 | 85.21 | <0.001 | 42.45 | 32.5 | 75.16 | 69.32 | <0.001 | |||||||
[i] Notes: BE = Belgium, SL = Slovenia, CA = Cambodia; ASR = age-standardized rate; n.a. = not available; n.s. = not significant; ano valid estimations of HTN prevalence available for Slovenia and thus also not for ‘being tested’ and ‘diagnosed’ among those with HTN; bThe p-value is obtained by a logistic regression model.
Figure 2
Gender stratified cascade of hypertension.
Note: The presented scores are age-standardised; see S6 for the corresponding data.
Table 3
Gender, education and financial situation regressed on the different bars of the cascade, using a logistic regression analysis (crude and adjusted odds ratios are presented).
| BELGIUM | ||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| IN CARE = 1 (AMONG THE DIAGNOSED; N = 1137) | IN TREATMENT = 1 (AMONG THE LINKED TO CARE; N = 1080) | |||||||||||||||||||
| CUDE OR | CI-95 | P-VALUE | AOR | CI-95 | P-VALUE | CRUDE OR | CI-95 | P-VALUE | AOR | CI-95 | P-VALUE | |||||||||
| Gender (ref. men) | ||||||||||||||||||||
| women | 1.96 | 0.94 | 4.08 | 0.072 | 1.84 | 0.88 | 3.86 | 0.105 | 0.91 | 0.50 | 1.64 | 0.745 | 1.20 | 0.67 | 2.13 | 0.545 | ||||
| Education (ref. high (higher secondary or higher)) | ||||||||||||||||||||
| low (primary school or lower) | 1.37 | 0.42 | 4.51 | 0.606 | 0.79 | 0.23 | 2.65 | 0.699 | 0.69 | 0.30 | 1.57 | 0.375 | 0.60 | 0.25 | 1.44 | 0.255 | ||||
| middle (lower secondary school) | 1.55 | 0.52 | 4.63 | 0.434 | 1.08 | 0.35 | 3.29 | 0.896 | 0.91 | 0.45 | 1.86 | 0.796 | 0.77 | 0.39 | 1.53 | 0.458 | ||||
| Financial situation (ref. good) | ||||||||||||||||||||
| poor | 1.06 | 0.45 | 2.5 | 0.891 | 1.00 | 0.41 | 2.47 | 0.992 | 0.42 | 0.20 | 0.87 | 0.02 | * | 0.37 | 0.18 | 0.77 | 0.008 | ** | ||
| moderate | 1.3 | 0.52 | 3.27 | 0.576 | 1.01 | 0.39 | 2.60 | 0.983 | 0.47 | 0.21 | 1.05 | 0.067 | 0.42 | 0.20 | 0.88 | 0.022 | * | |||
| ADHERENT TO TREATMENT = 1 (AMONG THOSE IN TREATMENT; N = 1042) | UNDER CONTROL = 1 (AMONG THOSE ADHERED TO TREATMENT)a | |||||||||||||||||||
| CRUDE OR | CI-95 | P-VALUE | ADJUSTED OR | CI-95 | P-VALUE | |||||||||||||||
| Gender (ref. men) | ||||||||||||||||||||
| women | 1.38 | 0.83 | 2.28 | 0.215 | 1.48 | 0.86 | 2.54 | 0.155 | ||||||||||||
| Education (ref. high (higher secondary or higher)) | ||||||||||||||||||||
| low (primary school or lower) | 0.62 | 0.29 | 1.33 | 0.221 | 0.37 | 0.16 | 0.83 | 0.016 | * | |||||||||||
| middle (lower secondary school) | 1.12 | 0.60 | 2.08 | 0.715 | 0.82 | 0.42 | 1.58 | 0.552 | ||||||||||||
| Financial situation (ref. good) | ||||||||||||||||||||
| poor | 1.31 | 0.75 | 2.29 | 0.345 | 1.25 | 0.71 | 2.20 | 0.445 | ||||||||||||
| moderate | 1.21 | 0.64 | 2.27 | 0.554 | 1.01 | 0.53 | 1.90 | 0.984 | ||||||||||||
| SLOVENIA | ||||||||||||||||||||
| IN CARE = 1 (AMONG THE DIAGNOSED; N = 22837)b | IN TREATMENT = 1 (AMONG THE LINKED TO CARE; N = 13061)b | |||||||||||||||||||
| CUDE OR | CI-95 | P-VALUE | AOR | CI-95 | P-VALUE | CRUDE OR | CI-95 | P-VALUE | AOR | CI-95 | P-VALUE | |||||||||
| Gender (ref. men) | ||||||||||||||||||||
| women | 1.09 | 1.04 | 1.15 | 0.001 | ** | 1.08 | 1.02 | 1.14 | 0.005 | ** | 1.36 | 0.96 | 1.92 | 0.082 | 1.29 | 0.91 | 1.83 | 0.153 | ||
| Education | // | // | // | // | ||||||||||||||||
| Financial situation | // | // | // | // | ||||||||||||||||
| ADHERENT TO TREATMENT = 1 (AMONG THOSE IN TREATMENT; N = 2051) | UNDER CONTROL = 1 (AMONG THOSE ADHERED TO CARE; N = 1873) | |||||||||||||||||||
| CRUDE OR | CI-95 | P-VALUE | AOR | CI-95 | P-VALUE | CRUDE OR | CI-95 | P-VALUE | AOR | CI-95 | P-VALUE | |||||||||
| Gender (ref. men) | ||||||||||||||||||||
| women | 1.26 | 0.93 | 1.72 | 0.143 | 1.25 | 0.91 | 1.74 | 0.173 | 1.29 | 1.07 | 1.54 | 0.007 | ** | 1.31 | 1.08 | 1.59 | 0.006 | ** | ||
| Education (ref. high (higher secondary or higher)) | ||||||||||||||||||||
| low (primary school or lower) | 1.11 | 0.74 | 1.74 | 0.620 | 1.18 | 0.76 | 1.88 | 0.470 | 1.12 | 0.88 | 1.45 | 0.359 | 1.09 | 0.84 | 1.42 | 0.497 | ||||
| middle (lower secondary school) | 1.21 | 0.84 | 1.78 | 0.322 | 1.26 | 0.87 | 1.87 | 0.231 | 1.04 | 0.84 | 1.29 | 0.747 | 1.07 | 0.86 | 1.34 | 0.518 | ||||
| Financial situation (ref. good) | ||||||||||||||||||||
| poor | 0.47 | 0.21 | 1.26 | 0.093 | 0.39 | 0.17 | 1.07 | 0.043 | * | 0.85 | 0.42 | 1.72 | 0.644 | 0.82 | 0.40 | 1.68 | 0.585 | |||
| moderate | 0.68 | 0.46 | 1.02 | 0.054 | 0.64 | 0.43 | 0.98 | 0.034 | * | 0.88 | 0.68 | 1.14 | 0.340 | 0.84 | 0.65 | 1.11 | 0.218 | |||
| CAMBODIA | ||||||||||||||||||||
| IN CARE = 1 (AMONG THE DIAGNOSED; N = 925) | IN TREATMENT = 1 (AMONG THE LINKED TO CARE; N= 917) | |||||||||||||||||||
| CUDE OR | CI-95 | P-VALUE | AOR | CI-95 | P-VALUE | CRUDE OR | CI-95 | P-VALUE | AOR | CI-95 | P-VALUE | |||||||||
| Gender (ref. men) | ||||||||||||||||||||
| women | 1.62 | 1.01 | 2.61 | 0.046 | * | 1.80 | 1.03 | 3.13 | 0.036 | * | 5.42 | 1.32 | 22.23 | 0.019 | * | 4.38 | 0.78 | 24.57 | 0.093 | |
| Education (ref. high (higher secondary or higher)) | ||||||||||||||||||||
| low (primary school or lower) | 0.92 | 0.23 | 3.61 | 0.906 | 1.24 | 0.35 | 4.39 | 0.739 | 0.83 | 0.10 | 6.98 | 0.869 | 0.36 | 0.03 | 4.18 | 0.414 | ||||
| middle (lower secondary school) | 0.75 | 0.16 | 3.40 | 0.708 | 1.01 | 0.23 | 4.39 | 0.985 | // | // | // | // | // | // | // | // | ||||
| Financial situation (ref. good) | ||||||||||||||||||||
| poor | 0.30 | 0.18 | 0.49 | 0.000 | *** | 0.27 | 0.16 | 0.46 | <0.001 | *** | 1.30 | 0.21 | 8.13 | 0.777 | 1.42 | 0.24 | 8.72 | 0.683 | ||
| moderate | 0.35 | 0.18 | 0.65 | 0.001 | *** | 0.37 | 0.19 | 0.72 | 0.003 | ** | 0.38 | 0.07 | 1.88 | 0.240 | 0.54 | 0.09 | 3.01 | 0.487 | ||
| ADHERED TO TREATMENT = 1 (AMONG THOSE IN TREATMENT; N = 522) | UNDER CONTROL = 1 (AMONG THOSE ADHERED TO CARE; N = 356) | |||||||||||||||||||
| CRUDE OR | CI-95 | P-VALUE | AOR | CI-95 | P-VALUE | CRUDE OR | CI-95 | P-VALUE | AOR | CI-95 | P-VALUE | |||||||||
| Gender (ref. men) | ||||||||||||||||||||
| women | 2.23 | 1.65 | 3.00 | 0.001 | *** | 2.11 | 1.57 | 2.84 | <0.001 | |||||||||||
| Education (ref. high (higher secondary or higher)) | ||||||||||||||||||||
| low (primary school or lower) | 1.11 | 0.47 | 2.57 | 0.810 | 0.63 | 0.28 | 1.34 | 0.251 | 1.04 | 0.39 | 2.77 | 0.925 | 0.52 | 0.21 | 1.31 | 0.166 | ||||
| middle (lower secondary school) | 0.99 | 0.38 | 2.58 | 0.993 | 0.71 | 0.28 | 1.75 | 0.460 | 0.91 | 0.29 | 2.84 | 0.870 | 0.62 | 0.21 | 1.82 | 0.383 | ||||
| Financial situation (ref. good) | ||||||||||||||||||||
| poor | 0.71 | 0.54 | 0.92 | 0.009 | ** | 0.74 | 0.56 | 0.99 | 0.045 | * | 0.70 | 0.51 | 0.95 | 0.025 | * | 0.74 | 0.52 | 1.04 | 0.088 | |
| moderate | 0.84 | 0.61 | 1.16 | 0.305 | 0.89 | 0.62 | 1.27 | 0.531 | 0.99 | 0.66 | 1.47 | 0.972 | 1.07 | 0.69 | 1.64 | 0.745 | ||||
[i] Notes: OR = odds ratio; AOR = adjusted odds ratio; adjusted for age, body mass index, current smoking status and comorbidity diabetes type 2; CI = Confidence interval; *p < 0.05 **p < 0.01 ***p < 0.001;
a the BELHES sample is only a subsample of the HIS sample and the sample size was too small for a logistic regression with outcome variable ‘under control’; b only adjusted for age; // = not able to estimate ORs because of small cells.