Provincial heterogeneity in the management of care cascade for hypertension, diabetes, and dyslipidaemia in China: Analysis of nationally representative population-based survey

Abstract

Background: This study aims to examine (1) province-level variations in the levels of cardiovascular disease (CVD) risk and behavioral risk for CVDs, (2) province-level variations in the management of cascade of care for hypertension, diabetes, and dyslipidaemia, and (3) the association of province-level economic development and individual factors with the quality of care for hypertension, diabetes, and dyslipidaemia.

Methods: We used nationally representative data from the China Health and Retirement Longitudinal Study in 2015, which included 12,597 participants aged 45 years. Using a care cascade framework, we examined the quality of care provided to patients with three prevalent NCDs: hypertension, diabetes, and dyslipidaemia. The proportion of WHO CVD risk based on the World Health Organization CVD risk prediction charts, Cardiovascular Risk Score (CRS) and Behavior Risk Score (BRS) were calculated. We performed multivariable logistic regression models to determine the individual-level drivers of NCD risk variables and outcomes. To examine socio-demographic relationships with CVD risk, linear regression models were applied.

Results: In total, the average CRS was 4.98 (95% CI: 4.92, 5.05), while the average BRS was 3.10 (95% confidence interval: 3.04, 3.15). The weighted mean CRS (BRS) in Fujian province ranged from 4.36 to 5.72 (P < 0.05). Most of the provinces had a greater rate of hypertension than diabetes and dyslipidaemia awareness and treatment. Northern provinces had a higher rate of awareness and treatment of all three diseases. Similar patterns of regional disparity were seen in diabetes and dyslipidaemia care cascades. There was no evidence of a better care cascade for CVDs in patients who reside in more economically advanced provinces.

Conclusion: Our research found significant provincial heterogeneity in the CVD risk scores and the management of the cascade of care for hypertension, diabetes, and dyslipidaemia for persons aged 45 years or more. To improve the management of cascade of care and to eliminate regional and disparities in CVD care and risk factors in China, local and population-based focused interventions are necessary.

Keywords: China; behavior risk; cardiovascular disease; care cascade; regional disparity.

Figure 1

The WHO CVD risk profile for Chinese adults aged 45 years and above by province, 2015. The recently updated non-laboratory-based WHO CVD risk prediction charts were used, which are recommended in the WHO Package of Essential Noncommunicable Disease Interventions. The higher the proportion, the higher the CVD risk.

Figure 2

The levels of cardiovascular risk and behavior risk by provinces in China, 2015. The gray area refers to provinces with a small sample size (<200 individuals). The white area refers to provinces without data available in CHARLS. CRS, Cardiovascular Risk Score; BRS, Behavior Risk Score. The higher the score, the higher the CVD risk.

Figure 3

The prevalence and cascade of care for hypertension, diabetes and dyslipidaemia in China.

Figure 4

Provincial-level variation in cascade of care for hypertension, diabetes and dyslipidaemia in China. The gray area refers to provinces with a small sample size (<200 individuals). The white area refers to provinces without data available in CHARLS.

Figure 5

Association between economic development and CVD care cascade indicators. Provinces are ranked according to the economic development in 2015 (The lowest GDP per capita, Gansu; the highest GDP per capita, Jiangsu).