Socio-economic inequalities in hypertension burden and cascade of services: nationwide cross-sectional study in Nepal

With an aim to examine the socio-economic inequalities in prevalence, awareness, treatment, and control of hypertension, this study analyzed 14,823 adults, 15 years or older with blood pressure measured, in the 2016 Nepal Demographic Health Survey. Multi-variable logistic regression and Lorenz curves were used to explore the inequalities. The prevalence of hypertension was 19.5% (95% CI: 18.3-20.7). Further, of the total hypertensive, the prevalence of hypertension awareness, treatment and control was 40.0% (95% CI: 37.5-42.6), 20.2% (95% CI: 18.0-22.2) and 10.5% (95% CI: 8.8-12.2), respectively. Participants with secondary (OR: 1.45, 95% CI: 1.20-1.76) and higher education (OR:1.42, 95% CI: 1.10-1.83), compared to those with no education/preschool, and those in urban residency (OR: 1.28, 95% CI: 1.09-1.50) compared to rural areas, and in province-4 (OR: 1.50, 95% CI: 1.14-1.96) and province-5 (OR: 1.34, 95% CI: 1.04-1.72), compared to province-1, had higher odds of being hypertensive. Household wealth status showed a positive association with prevalence, awareness, and treatment of hypertension (p-trend < 0.001). Those from richest category were 1.7 times more likely to be hypertensive, were more aware of hypertension (3.2 times), received treatment (5.1 times), and had controlled hypertension (1.6 times), compared to the poorest category. Adjusting for body mass index, completely ameliorate the effect on hypertension prevalence (p-trend = 0.57) and altered nominally awareness (p-trend < 0.0001), treatment (p-trend < 0.0001), and control (p-trend = 0.099). Urban hypertensive females, at the lowest wealth quintile, received poor care services; only 12% were aware of their hypertension status, 7% received treatment, and only 4% had controlled hypertension. These socio-economic inequalities warrant interventions aiming at preventing hypertension and increasing coverage of services for those higher at risk. Future studies need to explore socio-economic and geographic disparities in disease burden and cascade of services.