Gender Differences Of Prevalence And Control Of Hypertension In Rural Shandong, China

Great and profound changes have taken place in China over the past nearly 30 years. Rapid socioeconomic progress has exerted a great impact on everyday life and peoples lifestyles. Non-communicable chronic diseases (NCD) including hypertension have become the major threats to health in China. In recent years, the prevalence of hypertension in rural population increased rapidly and almost had the similar rate compared with urban population. The rates of awareness, treatment, and control in rural area were unbelievable lower. The prevalence of syndromes of hypertension was severity; hence the rates of disability and mortality were high in the rural population. So the hypertension in rural population has been an important public problem now and there is an urgent need for comprehensive integrated strategies to improve prevention, detection and treatment of hypertension in rural areas.Gender refers to the roles that men and women play and the relations that arise out of these roles, which are socially constructed, not biologically determined. Because of the different roles that men and women play in different society and culture context, there are gender different in access to opportunity and resources, and their ability about making decision and maintain human rights are different. Because of the gender roles and inequities gender relations interact with some societal and economic elements, gender differences are reflected in gender differences and inequalities in women's and men's vulnerability to illness, health status, access to preventative and curative measures, burdens of ill-health, and quality of care. There must be some differences in women's and men's knowledge on hypertension, chance on diagnosis, timely and validity of treatment and there are also sex differences in the reaction of physiology and pathology. These gender differences must produce gender disparities on prevalence, awareness, treatment, and control and relative factors of hypertension. Hence, in order to improve the prevention, detection and treatment of hypertension in rural areas, it will be necessary to understand gender differences on prevalence and control of hypertension, influence factors, characters on awareness and treatment process. There is no systematic analysis about gender differences on the prevalence, awareness, treatment, and control of hypertension in domestic study.The general objective of this study is: based on the theoretcial study and the evidence-based analysis, analysis the consecutive pathway of epidemiology and control of hypertension, explore the gender differences on the epidemilogy and control of hypertensin, and identify the impact factors of women's and men's prvalence, awareness, treatment and control of hypertension respectively and also explore the gender differences on those impact factors. The specific objectives include: explore the gender differences of the prevalence of hypertension, identify the gender differences in relative factors of hypertension prevalence, analysis women's and men's impact factors of prevalence of hypertension respectively; explore the gender differences of the awareness of hypertension and impact factors; explore the gender difference of the rate of treatment, the nonpharmacological and pharmacological treatments situation, and the impact factors of awareness, treatment, and control of hypertension.Date and MethodsThis study mainly used quantitative study methods. This study data is the baseline survey for the project "NCD community-base intervention in Shandong Province". We conducted a cross-sectional survey of rural adults aged 25 and above in Shandong Province using a multistage cluster sampling strategy. In the first stage, we selected eight counties; in the second stage, two townships were selected at random within each of the eight counties; in the third stage, two villages were randomly sampled within each township; in the fourth and final stage, all households within each selected village were listed and random select household. We developed a multi-item structured questionnaire to elicit the following information from study participants: demographic and socioeconomic characteristics, medical history, hypertension knowledge, and life-style related information. Physical exam included BP level, height, weight, and waist circumference. Surveys were conducted simultaneously in all eight counties between 15 April 2007 and 2 May 2007 by well trained staff from CDC and local hospital. Hypertension was defined as SBP>140mm Hg and/or DBP>90mm Hg, and/or self-reported current use of antihypertensive medication (irrespective of the level of blood pressure). Data analyses were conducted using SPSS 11.5 software. The descriptive statistical analysis, single factor analysis and multiple logistic regression analysis were the main analysis methods.Main results(1) Gender differences on social-economic and general health status: The overall social, economic, and culture status of female reflected by some variables is lower than male. Women's education level was lower than men: women's illiterate rate was 30% higher than men's; nearly 90% of elder women were illiterate, especially. Compared with women, more men did paid job such as managers, skilled and blue-collar workers. Men's self-rated social status was higher than women and women's self-rated health status was higher than men. Men would go to higher level health facility when they were sick and men's health expenditure decision making power was higher than women.(2) Gender differences on hypertension prevalence and relative factors: the study results showed that men's hypertension prevalence was higher than women's (men: 47.8%, women: 40.8%). Even after adjusted by standard population, men still had higher prevalence than women (men: 41.2%, women: 34.3%). In early adult and middle age, men's prevalence of hypertension was higher than women's. In 55-65 years old, women had similar prevalence of hypertension with men due to the bigger increase rate of women. After that, women had higher hypertension prevalence than men. Although women's prevalence was lower than men's, women's grade of hypertension was higher than men's and the prevalence of isolate systolic hypertension of women was higher than men's.Men and women had different lifestyle, health consciousness, hypertension knowledge, and prevention behaviors. Men had higher smoking rate and excess alcohol drinking rate. Women had higher overweight and obesity rate, second hand smoking rate, exercise rate than men, and more women self-reported bad sleep situation. The proportion of learning initiatively health knowledge was higher for men compared with women and the desire to learn hypertension knowledge was also higher for men than women. Hence, the knowledge about hypertension of men was higher than women. But women's prevention behaviors were better than men such as blood pressure measurement, weight control.(3) Gender differences on hypertension awareness and relative factors: in general, the men's rate of awareness of hypertension was lower than women's (man: 24.3%, women: 27.9%). The gender differences of middle age population was biggest, however there were no gender differences of awareness in younger and older population. More men were diagnosed of hypertension before our survey was under the circumstances of physical exam or other diseases compared with women. Among the patients who were aware of their hypertension, men have better knowledge about hypertension and better understood of their state of hypertension.(4) Gender differences on hypertension treatment and relative factors: Among all hypertensive, men's rate of treatment of hypertension was 2.8% lower than women (man: 20.5%, woman: 23.3%), but among patients who were aware of their hypertension, men and women had same rates of treatment (man: 84.5%, woman: 83.7%).Health providers didn't prescribe effective and suitable nonpharmacological therapies, especially for women patients. General speaking, more men reported bad compliance with nonpharmacological therapies compared with women. The main reasons given for not complying with nonpharmacological treatments were different among men and women: the proportion of "habits could not be changed" selected by men was higher than women, however the proportion of "lack of knowledge about hypertension" selected by women was higher than men. Male hypertension patients took more kinds of antihypertension medicines than female patients. There were no gender differences on proportion of good compliance with pharmacological therapies. The main form of not compliance with pharmacological therapies was stop taking medicines, more women selected this option. There were no gender differences on the reason of not compliance with pharmacological therapies. Male and female's health expenditures on hypertension pharmacological therapies were similar. Female preferred to village clinics or other private clinics for hypertension treatment than male.(5) gender differences on hypertension control: Among all hypertension patients, female were more control of their blood pressure under 140/90mm Hg compared with male (male: 3.3%, female: 4.4%), but the control of hypertension was far away from satisfaction. Among those who were under pharmacological therapies, only 17% of their blood pressures were well controlled, but no gender differences on control rate (male: 16.3%, female: 18.7%).Conclusions and policy implicationsThe characters of epidemiology of hypertension in rural Shandong Province were high prevalence, low awareness rate, low treatment rate, and low control rate. Hypertension has been an important public problem which has been a big threat of population health status. It is urging to improve the prevention and control abilities of hypertension in rural population, Shandong.Before 55 years old, hypertension prevalence in men was higher than that in women. After 65 years old, hypertension prevalence in women increased rapidly and higher than men. Women also had higher rate of awareness, treatment, and control of hypertension than men, but among those who were aware of their hypertension, there was no gender differences in rate of treatment, and also among those who were under pharmacological therapies, there was no gender differences in rate of BP control. Hence, the main point of gender equity in epidemiology and control of hypertension is reducing gender difference on awareness through increase men's rate of awareness. Male and female had different espouse level and sensitive level of relative risk factors of prevalence, awareness, treatment, and control of hypertension. We should consider different characters of male and female when making hypertension prevention and control policy to improve the ability of prevention, detection and treatment of hypertension in rural areas, and reduce gender differences.According the results, we make following advice: 1) improve the education level of rural population to reduce illiterate rate of adult, especially female; 2) strengthen health education of hypertension through special strategies and contents to different population (general population or high risk population); 3) strengthen the important role of female in health education process because that female are always the food provider and health care of family member and female can be well influenced by peer; 4) advocate good lifestyle and perform different theme health education to different gender population: for male, pay more attention to smoking quit and reduce alcohol prevention, for female, pay more attention to diet, exercise, mental health; 5) establish system of measure blood pressure at first visiting health facilities to ensure blood pressure of all adult who will seek health service in village, township, and county health facilities will be measured in order to diagnose hypertension earlier.