Key result
Undiagnosed hypertension accounts for ~76% of all adult cases in Indonesia, concentrated among rural women.
Why the study?
A large proportion of people with hypertension in LMICs remain undiagnosed, and analyses examining disparities in undiagnosed versus diagnosed hypertension are lacking.
Does geographic and socioeconomic disparity patterning differ between diagnosed and undiagnosed hypertension among adults across 514 districts in Indonesia?
Cross-Sectional (n=624,563)
Yes
Does geographic and socioeconomic disparity patterning differ between diagnosed and undiagnosed hypertension among adults across 514 districts in Indonesia?
Over three-quarters (76.3%) of adults with hypertension in Indonesia are undiagnosed, with distinct socioeconomic and urban-rural disparity patterns between diagnosed and undiagnosed cases that require targeted health system reforms and screening in rural and lower-educated female populations.
BACKGROUND: Healthcare systems in many low- and middle-income countries (LMICs) are not yet designed to tackle the high and increasing burden of non-communicable diseases (NCDs), including hypertension. As a result, a large proportion of people with disease or risk factors are undiagnosed. Policymakers need to understand the disparity better to act. However, previous analyses on the disparity in undiagnosed hypertension, especially from LMICs, are lacking. Our study assessed the geographic and socioeconomic disparity in undiagnosed hypertension and compared it with diagnosed hypertension. METHODS: We used the Basic Health Survey (Riskesdas) 2018 and performed geospatial and quantitative analyses across 514 districts in Indonesia. Dependent variables included diagnosed and undiagnosed hypertension among adults (18+ years) and by gender. RESULTS: A high prevalence of undiagnosed hypertension at 76.3% was found, with different patterns of disparity observed between diagnosed and undiagnosed hypertension. Diagnosed hypertension was 1.87 times higher in females compared with males, while undiagnosed hypertension rates were similar between genders. Urban areas had up to 22.6% higher rates of diagnosed hypertension, while undiagnosed hypertension was 11.4% more prevalent among females in rural areas. Districts with higher education rates had up to 25% higher diagnosed hypertension rates, while districts with lower education rates had 6% higher rates of undiagnosed hypertension among females. The most developed regions had up to 76% and 40% higher prevalence of both diagnosed and undiagnosed hypertension compared with the least developed regions. CONCLUSION: The disparity patterning differs between diagnosed and undiagnosed hypertension among adults in Indonesia. This highlights the need for effective measures, including healthcare system reforms to tackle NCDs in LMICs.
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Oktamianti et al. (2023) conducted a cross-sectional in Diagnosed and undiagnosed hypertension (n=624,563). Geographic and socioeconomic factors (region, urbanicity, district poverty rate, and senior secondary education enrollment) vs. Least developed regions, rural areas, poorest districts, and least educated districts was evaluated on Prevalence of diagnosed and undiagnosed hypertension among adults across geographic and socioeconomic strata (p=<0.05). Undiagnosed hypertension accounted for 76.3% of all adult hypertension in Indonesia (25.4% undiagnosed vs 7.9% diagnosed prevalence), with higher undiagnosed rates among rural and less-educated women.
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