Passi Solar, Álvaro Rodrigo;
(2022)
Socioeconomic inequalities in the prevalence and management of hypertension: analyses of the Chilean National Health Surveys 2003, 2010 and 2017.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Background: Up-to-date information on hypertension prevalence and management indicators (awareness, treatment, control); measures of its socioeconomic inequalities; and their impacts are required in Chile. This PhD aims to quantify the prevalence of these indicators, the magnitude of their socioeconomic inequalities, and their association with mortality risk among adults in Chile 2003, 2010, and 2017. Methods: First, using 2003, 2010, and 2017 Chilean national health surveys (ENS) I analysed secular changes in levels of hypertension outcomes by demographic variables. Secondly, I analysed socioeconomic position (SEP) inequalities in hypertension outcomes using individual-level measures (educational level, income, and health insurance). Thirdly, using a multilevel approach, I evaluated the association between individual educational level and hypertension prevalence, before and after adjustment for socioeconomic environment measures (county-level income inequality, poverty, and unemployment). Finally, I analysed all-cause and cardiovascular mortality rates by educational level and hypertension status using ENS data linked with mortality registries. Results: Between 2003 and 2017, hypertension prevalence decreased (34%-31%), awareness increased slightly (58%-66%), whereas treatment (38%-65%) and control (13%-34%) levels increased substantially. Hypertension management levels were lower among males than females. Secondly, hypertension prevalence was higher among adults with lower levels of education. Inequalities by education in hypertension prevalence, untreated, and uncontrolled hypertension were more pronounced among females. Thirdly, multilevel analyses showed that the magnitude of inequalities by education level were minimally affected by socioeconomic environment measures. Finally, I found a higher risk of all-cause and cardiovascular mortality in participants with hypertension and at the lowest educational level. Conclusions: Despite favourable changes in hypertension outcomes over time, Chile currently needs innovative and collaborative strategies to improve hypertension management (especially among males), and simultaneously decrease SEP inequalities in hypertension outcomes (mainly among females). Interventions decreasing hypertension prevalence, improving hypertension management, and increasing educational levels could help to decrease the burden of premature mortality.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Socioeconomic inequalities in the prevalence and management of hypertension: analyses of the Chilean National Health Surveys 2003, 2010 and 2017 |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2022. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10161470 |
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