| BackgroundHypertension is a major risk factor for cardiovascular diseases and kidney diseases.It has become one of the most serious public health problem in China.Since the reform and opening up,the rapidly development of China's economy and the imbalance of regional economic development have led to the considerable movement of rural labor force,which has promoted a large increase of the floating population.The accurate estimation of the level of prevalence,awareness,treatment and control of hypertension of the floating workers in China and its influencing factors are of reference value for the policy of equalization of basic public services for the floating population.ObjectiveThe purpose of this study is to estimate the prevalence,awareness,treatment and control of hypertension in the 18?59 years of the employment of floating population in China,and to explore the influencing factors,and to find out the influence of flow characteristics(flow direction,flow mode,residential area and medical insurance,etc)on the prevalence of hypertension,awareness,treatment and control of the floating population,and puts forward policy recommendations for prevention and control of hypertension in floating population in China.Methods1.This study was based on the "chronic disease risk factor survey among floating population in China",this study conducted a survey on 170 counties(districts)of 31 provinces(autonomous regions and municipalities directly under the Central Government),and all subjects were choosen by stratified multi-stage cluster sampling.The information of demographic information,flow characteristics(intergenerational division,medical insurance situation,flow pattern,flow direction,living area),behavior lifestyle(smoking,drinking,diet,physical activity),and the disease and control of major chronic diseases(diabetes,hypertension,dyslipidemia,etc.)were collected through a questionnaire.At the same time,height,weight,waist circumference and blood pressure of each investigator were measured.After data cleaning,48704 18-59 year-old migrant workers were enrolled in the study.2.Statistical analysis was carried out by using the dynamic monitoring data of floating population conducted by The National Health and Family Planning Commission in 2012.The estimation of the prevalence rate of the 18-59 year old migrant population in China is obtained after weighted,and the sampling error and the 95%confidence intervalare calculated by using the Taylor Series Linearization.Rao-Scott Chi square test was used to test the difference of rate.The trend of rate was analyzed by chi square trend test.Two blood pressure level was expressed by mean and standard deviation.The difference of blood pressure between two groups was compared by rank sum test.The two level(provincial and personal)Logistic empty model was constructed,and the difference of hypertension related indexes in each province was measured by the median ratio Ratio.Based on the empty model,the independent variables such as demographic information and risk factors,flow characteristics and regional factors were gradually included,we compared the provincial level variance and calculate the proportional change in variance,so as to measure the explanation degree of different independent variables to provincial differences.ResultsIn 2012,the mean(standard deviation)of systolic blood pressure(standard deviation)of 18-59 year old workers in China was 120.7(15.6)mmHg,diastolic pressure was 77.3(11.1)mmHg,and the prevalence of hypertension was 15.6%(95%CI:15.2?16.0%).In hypertensive patients,24.3%(95%CI:23.2%-25.5%)knew that they had hypertension,12%(95%CI:11.2?12.9%)received antihypertensive treatment,and 2.9%(95%CI:2.6-3.3%)controlled the blood pressure to the target level.Compared with the corresponding gender and age resident in 2013,the prevalence rate of hypertension in the migrant workers is lower,but the level of awareness and treatment is lower and the control effect is not good.After the weighted adjustment of age and sex,the prevalence rate of hypertension in the 18-59 year-old male migrant population in China was higher than that of female(male 34.5%,female 29.5%,p<0.05),and the prevalence rate of hypertension increased with age and decreased with the increase of educational level;the prevalence of hypertension was different in different flow directions,and the rate in the South to north.The migrants were higher than the northern migrants,and the north to South floating people were higher than those in the south.The prevalence of hypertension was higher(p<0.05)in which was born before 1980.The level of awareness,treatment and control of hypertension patients with different demographic and flow characteristics was different,people who were older and had higher the level of education were in company with the level of awareness,treatment and control was higher(trend test p<0.05);men and people who places had no medical insurance,cross provincial or cross city flow,and migrant workers in the south flow hypertension patients.People had lower awareness,treatment and control level(p<0.05).The multilevel Logistic regression model showed that the hypertension related indexes were different at the provincial level,the MOR of prevalence rate was 1.38(95%CI:1.25-1.48),the MOR of awareness rate was 1.31(95%CI:1.18-1.41),the MOR of rate of treatment was 1.12(95%CI:1.04-1.21),and the MOR of control rate was 1.68(95%CI:1.33-1.96).The differences in demography characteristics,such as age,sex,and risk factors,such as smoking,excessive drinking,overweight,obesity,and educational level,can explain 33.08%difference in the prevalence of hypertension among provinces.The differences in medical insurance,flow pattern,flow direction and living area can explain 26.32%difference between provinces.19.72%difference in hypertension patients' awareness rate,24.14%difference in treatment rate and 18.12%difference in control rate between provinces could be explained by the difference in demographic composition.19.72%difference in hypertension patients' awareness rate,6.89%difference in treatment rate and 34.9%difference in control rate between provinces could be explained by the difference of flow characteristics.The differences in medical insurance,flow pattern,flow direction and living areas in different provinces have a certain explanatory effect on the differences in the level of hypertension,awareness,treatment and control rate.ConclusionsIn China,the prevalence of hypertension is generally prevalent among 18?59 year-old floating population.The awareness and treatment level of patients with hypertension is relatively low,and the control effect is not good,and the situation of prevention and control is serious.The floating population in China may face huge potential risk of cardiovascular and cerebrovascular disease.There were differences in the prevalence rate of hypertension,awareness,treatment and control of the floating population with different flow characteristics,and the most serious and poor control of hypertension was observed in the south to north floating people.About 1/7 of the migrant workers were not buying medical insurance in the household and inflow areas,and they had lower hypertension awareness rate,treatment rate and control rate.The situation of hypertension prevention and control is more serious among the floating population in the western region.The flow characteristics including medical insurance,flow pattern,flow direction and living area are related to the prevalence rate of hypertension,awareness,treatment and control.Which could explain the differences of hypertension related indexs to a certain extent.For the long distance floating population,the health education should be strengthened so as to prevent the unhealthy behavior lifestyle formed by the change of the environment.Relevant departments should improve the coverage rate of medical insurance for floating population and solve the difficulties of reimbursement in other places.For floating population who was current employmeed in western area,we should increase the policy support and capital investment for prevention and control of hypertension. |
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