What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Hypertension (n=93787). Primary outcome: National hypertension prevalence (95% CI 28.7-30.9).

March 6, 2020Open Access

Geographical influence on the distribution of the prevalence of hypertension in South Africa: a multilevel analysis

Key Result

Significant geographical variation in hypertension prevalence remained between districts in South Africa after adjusting for individual risk factors, with an overall national prevalence of 29.8%.

Study Design

Type

Cross-Sectional (n=93,787)

Multicenter

Yes

Structured PICO

Population

93,787 South African adults aged 15 years and above from the National Income Dynamics Study (NiDS) panel survey (waves 2008, 2010/11, 2012, 2014/15, 2017) with valid blood pressure measurements.

Outcome

Hypertension prevalence (systolic/diastolic BP > 140/90 mmHg or on medication for hypertension) at the district level

Significant geographic variation in hypertension prevalence exists across South African districts independent of individual risk factors, suggesting a need for targeted local public health interventions.

Limitations

Samples at the district level were not large enough, resulting in wide confidence intervals for the estimated prevalence rates.
Inability to fully adjust for ambient temperatures since these measurements were not available in the data set.
Lack of detailed data on ethnicity or tribe within racial groups, particularly for black South Africans.
Unavailability of data on diet and cultural differences in food intake, such as salt and sugar consumption.

Abstract

BACKGROUND: As a response to the growing burden of non-communicable diseases, the South African government has set targets to reduce the prevalence of people with raised blood pressure, through lifestyle changes and medication, by 20% by the year 2020. It has also recognised that the prevalence varies at local administrative level. The study aim was to determine the geographical variation by district of the prevalence of hypertension among South African adults aged 15 years and above. METHODS: Data from all five waves of the National income Dynamics Study, a panel survey, were used for estimation by both design-based and multilevel analysis methods. In the multilevel analysis, a three-level hierarchy was used with panel participants in the first level, repeated measurements on patients in the second level, and districts in the third level. RESULTS: After accounting for demographic, behavioural, socio-economic and environmental factors, significant variation remained in the prevalence of hypertension at the district level. Districts with higher-than-average prevalence were found mostly in the south-western part of the country, while those with a prevalence below average were found in the northern area. Age, body mass index and race were the individual factors found to have a strong effect on hypertension prevalence for this sample. CONCLUSIONS: There were significant differences in hypertension prevalence between districts and therefore the method of analysis and the results could be useful for more targeted preventative and control programmes.

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