Awareness and diagnoses of hypertension and diabetes in China has been limited, resulting in compromised treatment; and increased screening did not lead to significant improvements, according to a new study at Columbia University Mailman School of Public Health. Findings are online in the journal BMC Public Health. Until now; there was little information on how individuals with hypertension or diabetes in China first became aware of their conditions and what factors may have contributed to changes in awareness over time.

Compromised treatment

“It does not seem that the screening activities implemented by a national health survey improved awareness and management of these conditions. The persistent limited awareness of diabetes and hypertension remains a major public health concern,” said L.H. Lumey, MD, professor of Epidemiology.

Using data from the China Health and Retirement Longitudinal Study (CHARLS), therefore researchers measured the impact of a screening program for people aged 45 years and older between 2011 and 2015. Therefore After 2011, study participants are re interview every two years to monitor any changes over time in their health, economic; or social conditions. Because Physical examinations are repeat in 2013 and 2015; and participants are ask again if they had ever been diagnose with hypertension, or diabetes.

Hypertension remains

Over 80% of participants interviewed in 2011 continued to participate in 2015. Of the more than 11,000 people screened in 2011, 49% were identified with hypertension and 18% with diabetes by medical examinations. Because Over 80% of the middle-aged and elderly Chinese diagnosed with hypertension and/or diabetes in 2011 reported in 2015 that they were unaware of having the disease(s). Because Aware hypertension patients were more likely to be older women, live in urban areas; and have higher BMIs.

Hypertension is define as diastolic blood pressure of 90 mmHg or higher; a systolic blood pressure of 140 mmHg or higher; or both; or as currently using an anti-hypertensive medication. Because Diabetes is define as a fasting plasma glucose level of 126 mg/dL or higher; an HbA1c concentration of 6.5 mg/dL or higher; or a self-report of doctor diagnosed diabetes.

Systolic blood pressure

There was some improvement in disease awareness between 2011 and 2015; mostly attributed to a medical examination initiated by the study participants themselves, by their work unit or community; but rarely  by the CHARLS examination. Because “One possible explanation is that the screening in the health survey is seen simply as an isolate process and not as a tool for follow-up, treatment, or referral,” noted Lumey.
Several reasons could explain the limited increase in reported disease awareness in 2015; according to the researchers. Some participants may not have received the physical examination and blood test results from the 2011 survey; therefore they may have not understood the results; or, they may have forgotten the results. “They also are unwilling to recognize that they had been diagnose with diabetes or hypertension or fail to take appropriate measures for disease management;” said Lumey. “This will need further study.”