Study on regional and urban-rural disparities in the hypertension incidence of Chinese adults: based on longitudinal dynamic cohort of CHNS_Chinese Journal of Evidence-Based Medicine

Authors：

LUO Yunmei , ZENG Zhi , HE Wenbo ,  ZHANG Wei

1. Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

ZHANG Wei, Email: weizhanghx@163.com

Keywords：

Hypertension; Incidence; Region; Urban-rural; Chinese adult

DOI：

10.7507/1672-2531.202312191

Video：

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Objective To explore the regional and urban-rural disparities in the hypertension incidence of Chinese adults. Methods Based on the data from the China Health and Nutrition Survey (CHNS), as well as the consumption level and altitude data from the National Bureau of Statistics and government official website, a robust multilevel Poisson regression was performed to explore the regional and urban-rural disparities in the hypertension incidence of Chinese adults, according to data and design types. Results According to the inclusion and exclusion criteria, 11 579 subjects and totaling 50 957 lines of data were enrolled. The 24 years follow-up results indicated that the crude incidence density of hypertension was 37.08/1 000 person years, with 40.51/1 000 person years for males and 34.13/1 000 person years for females. The robust multilevel Poisson regression results indicated that, by adjusting the high-level factors such as time, the proportion of the community mainly engaged in agricultural labor, and the consumption level of subjects, as well as sociodemographic characteristics such as age and gender, the Middle (RR=1.20, 95%CI 1.04 to 1.39), Northeast (RR=1.25, 95%CI 1.03 to 1.52), and Eastern (RR=1.25, 95%CI 1.05 to 1.48) China had a higher risk of developing hypertension than the Western China. The risk of hypertension in urban area was lower than that in rural area (RR=0.87, 95%CI 0.77 to 0.96). Conclusion The incidence density of hypertension in China is relatively high, and male is higher than female. The incidence of hypertension in the Western China is lower than that in the Middle, Northeast and Eastern China, and urban area is lower than rural area.

Citation： LUO Yunmei, ZENG Zhi, HE Wenbo, ZHANG Wei. Study on regional and urban-rural disparities in the hypertension incidence of Chinese adults: based on longitudinal dynamic cohort of CHNS. Chinese Journal of Evidence-Based Medicine, 2024, 24(4): 414-422. doi: 10.7507/1672-2531.202312191 Copy

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3.	Ou YN, Tan CC, Shen XN, et al. Blood pressure and risks of cognitive impairment and dementia: a systematic review and meta-analysis of 209 prospective studies. Hypertension, 2020, 76(1): 217-225.
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9.	Dorjgochoo T, Shu XO, Zhang X, et al. Relation of blood pressure components and categories and all-cause, stroke and coronary heart disease mortality in urban Chinese women: a population-based prospective study. J Hypertens, 2009, 27(3): 468-475.
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11.	李国奇, 刘静, 王薇, 等. 中国35-64岁人群15年高血压发生风险预测研究. 中华内科杂志, 2014, 53(4): 265-268.
12.	Liang Y, Liu R, Du S, et al. Trends in incidence of hypertension in Chinese adults, 1991-2009: the China Health and Nutrition Survey. Int J Cardiol, 2014, 175(1): 96-101.
13.	Liu Q, Huang K, Liang F, et al. Long-term exposure to fine particulate matter modifies the association between physical activity and hypertension incidence. J Sport Health Sci, 2022, 11(6): 708-715.
14.	Lu YK, Dong J, Sun Y, et al. Gender-specific predictive ability for the risk of hypertension incidence related to baseline level or trajectories of adiposity indices: a cohort study of functional community. Int J Obes (Lond), 2022, 46(5): 1036-1043.
15.	韩雪玉, 齐玥, 赵冬, 等. 中国人群长期血压变化与心血管病发病风险关系的前瞻性队列研究. 中华心血管病杂志, 2018, 46(9): 695-700.
16.	Cai C, Liu FC, Li JX, et al. Effects of the total physical activity and its changes on incidence, progression, and remission of hypertension. J Geriatr Cardiol, 2021, 18(3): 175-184.
17.	Yao F, Liu W, Zhao R, et al. BMI modified the association of current smoking with the incidence of hypertension in Chinese population: a 22-year cohort study. BMC Public Health, 2020, 20(1): 295.
18.	Cheng H, Gu Y, Ma X, et al. Urban-rural disparities in hypertension prevalence, awareness, treatment, and control among Chinese middle-aged and older adults from 2011 to 2015: a repeated cross-sectional study. BMC Cardiovasc Disord, 2022, 22(1): 319.
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20.	Yu Q, Lin S, Wu J. Hypertension prevalence rates among urban and rural older adults of China, 1991-2015: a standardization and decomposition analysis. Front Public Health, 2021, 9: 713730.
21.	Wang Z, Chen Z, Zhang L, et al. Status of hypertension in china: results from the China hypertension survey, 2012-2015. Circulation, 2018, 137(22): 2344-2356.
22.	张梅, 吴静, 张笑, 等. 2018年中国成年居民高血压患病与控制状况研究. 中华流行病学杂志, 2021, 42(10): 1780-1789.
23.	Popkin BM, Du S, Zhai F, et al. Cohort profile: the China Health and Nutrition Survey-monitoring and understanding socio-economic and health change in China, 1989-2011. Int J Epidemiol, 2010, 39(6): 1435-1440.
24.	"中国健康与营养调查"项目组. 1989-2009年中国九省区居民膳食营养素摄入状况及变化趋势(一)健康与营养调查项目总体方案. 营养学报, 2011, 33(3): 234-236.
25.	Gao M, Kuang W, Qiu P, et al. The time trends of cognitive impairment incidence among older Chinese people in the community: based on the CLHLS cohorts from 1998 to 2014. Age Ageing, 2017, 46(5): 787-793.
26.	张兵, 王惠君, 杜文雯, 等. 1989-2009年中国九省区居民膳食营养素摄入状况及变化趋势(二)18-49岁成年居民膳食能量摄入状况及变化趋势. 营养学报, 2011, 33(3): 237-242.
27.	牟红安, 鲍勇. 老年人概念和适老化生活环境需求研究. 智库时代, 2019, 25(22): 1-2.
28.	中国肥胖问题工作组. 中国成人超重和肥胖症预防与控制指南(节录). 营养学报, 2004, 26(1): 1-4.
29.	中国营养学会肥胖防控分会, 中国营养学会临床营养分会, 中华预防医学会行为健康分会, 等. 中国居民肥胖防治专家共识. 中国预防医学杂志, 2022, 23(5): 321-339.
30.	《中国高血压防治指南》修订委员会. 中国高血压防治指南(2018年修订版). 中国心血管杂志, 2019, 24(1): 24-56.
31.	孙佳艺, 赵冬, 王薇, 等. 北京地区2 740人的血压水平10年(1992-2002)变化情况. 高血压杂志, 2005, 13(2): 115-119.
32.	Tan M, He FJ, Wang C, et al. Twenty-four-hour urinary sodium and potassium excretion in china: a systematic review and meta-analysis. J Am Heart Assoc, 2019, 8(14): e012923.
33.	Li Z, Cao L, Zhou Z, et al. Factors influencing the progression from prehypertension to hypertension among Chinese middle-aged and older adults: a 2-year longitudinal study. BMC Public Health, 2023, 23(1): 339.
34.	Zhang X, Zhang M, Zhao Z, et al. Geographic variation in prevalence of adult obesity in China: results from the 2013-2014 national chronic disease and risk factor surveillance. Ann Intern Med, 2020, 172(4): 291-293.
35.	房玥晖, 何宇纳, 白国银, 等. 2012年中国20-79岁男性饮酒现状分析. 中华流行病学杂志, 2018, 39(3): 280-285.
36.	《中国居民健康素养监测报告(2018年)》发布. 上海医药, 2019, 40(17): 33.
37.	陈菲. 基于全民健康覆盖的基本公共卫生公平研究. 华中科技大学, 2020.
38.	张艺宏, 王梅, 孙君志, 等. 2014年中国城乡居民超重肥胖流行现状—基于22省(市、区)国家国民体质监测点的形态数据. 成都体育学院学报, 2016, 42(5): 93-100.
39.	He J, Ouyang N, Guo X, et al. Effectiveness of a non-physician community health-care provider-led intensive blood pressure intervention versus usual care on cardiovascular disease (CRHCP): an open-label, blinded-endpoint, cluster-randomised trial. Lancet, 2023, 401(10380): 928-938.

1. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1 201 population-representative studies with 104 million participants. Lancet, 2021, 398(10304): 957-980.
2. Cherbuin N, Walsh EI, Shaw M, et al. Optimal blood pressure keeps our brains younger. Front Aging Neurosci, 2021, 13: 694982.
3. Ou YN, Tan CC, Shen XN, et al. Blood pressure and risks of cognitive impairment and dementia: a systematic review and meta-analysis of 209 prospective studies. Hypertension, 2020, 76(1): 217-225.
4. Schaare HL, Kharabian Masouleh S, Beyer F, et al. Association of peripheral blood pressure with gray matter volume in 19- to 40-year-old adults. Neurology, 2019, 92(8): e758-e773.
5. GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1204-1222.
6. GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1223-1249.
7. GBD 2019 Demographics Collaborators. Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1160-1203.
8. Campbell NRC, Zhang XH. Hypertension in China: time to transition from knowing the problem to implementing the solution. Circulation, 2018, 137(22): 2357-2359.
9. Dorjgochoo T, Shu XO, Zhang X, et al. Relation of blood pressure components and categories and all-cause, stroke and coronary heart disease mortality in urban Chinese women: a population-based prospective study. J Hypertens, 2009, 27(3): 468-475.
10. Liao CT, Wu PC, Shih JC, et al. Higher hypertension prevalence, lower incidence, and aggressive treatment with decreasing mortality, cardiovascular, and cerebrovascular incidence in Taiwan from 2005 to 2010: a 2 population-based cohorts study. Medicine (Baltimore), 2020, 99(39): e22437.
11. 李国奇, 刘静, 王薇, 等. 中国35-64岁人群15年高血压发生风险预测研究. 中华内科杂志, 2014, 53(4): 265-268.
12. Liang Y, Liu R, Du S, et al. Trends in incidence of hypertension in Chinese adults, 1991-2009: the China Health and Nutrition Survey. Int J Cardiol, 2014, 175(1): 96-101.
13. Liu Q, Huang K, Liang F, et al. Long-term exposure to fine particulate matter modifies the association between physical activity and hypertension incidence. J Sport Health Sci, 2022, 11(6): 708-715.
14. Lu YK, Dong J, Sun Y, et al. Gender-specific predictive ability for the risk of hypertension incidence related to baseline level or trajectories of adiposity indices: a cohort study of functional community. Int J Obes (Lond), 2022, 46(5): 1036-1043.
15. 韩雪玉, 齐玥, 赵冬, 等. 中国人群长期血压变化与心血管病发病风险关系的前瞻性队列研究. 中华心血管病杂志, 2018, 46(9): 695-700.
16. Cai C, Liu FC, Li JX, et al. Effects of the total physical activity and its changes on incidence, progression, and remission of hypertension. J Geriatr Cardiol, 2021, 18(3): 175-184.
17. Yao F, Liu W, Zhao R, et al. BMI modified the association of current smoking with the incidence of hypertension in Chinese population: a 22-year cohort study. BMC Public Health, 2020, 20(1): 295.
18. Cheng H, Gu Y, Ma X, et al. Urban-rural disparities in hypertension prevalence, awareness, treatment, and control among Chinese middle-aged and older adults from 2011 to 2015: a repeated cross-sectional study. BMC Cardiovasc Disord, 2022, 22(1): 319.
19. Ma S, Yang L, Zhao M, et al. Trends in hypertension prevalence, awareness, treatment and control rates among Chinese adults, 1991-2015. J Hypertens, 2021, 39(4): 740-748.
20. Yu Q, Lin S, Wu J. Hypertension prevalence rates among urban and rural older adults of China, 1991-2015: a standardization and decomposition analysis. Front Public Health, 2021, 9: 713730.
21. Wang Z, Chen Z, Zhang L, et al. Status of hypertension in china: results from the China hypertension survey, 2012-2015. Circulation, 2018, 137(22): 2344-2356.
22. 张梅, 吴静, 张笑, 等. 2018年中国成年居民高血压患病与控制状况研究. 中华流行病学杂志, 2021, 42(10): 1780-1789.
23. Popkin BM, Du S, Zhai F, et al. Cohort profile: the China Health and Nutrition Survey-monitoring and understanding socio-economic and health change in China, 1989-2011. Int J Epidemiol, 2010, 39(6): 1435-1440.
24. "中国健康与营养调查"项目组. 1989-2009年中国九省区居民膳食营养素摄入状况及变化趋势(一)健康与营养调查项目总体方案. 营养学报, 2011, 33(3): 234-236.
25. Gao M, Kuang W, Qiu P, et al. The time trends of cognitive impairment incidence among older Chinese people in the community: based on the CLHLS cohorts from 1998 to 2014. Age Ageing, 2017, 46(5): 787-793.
26. 张兵, 王惠君, 杜文雯, 等. 1989-2009年中国九省区居民膳食营养素摄入状况及变化趋势(二)18-49岁成年居民膳食能量摄入状况及变化趋势. 营养学报, 2011, 33(3): 237-242.
27. 牟红安, 鲍勇. 老年人概念和适老化生活环境需求研究. 智库时代, 2019, 25(22): 1-2.
28. 中国肥胖问题工作组. 中国成人超重和肥胖症预防与控制指南(节录). 营养学报, 2004, 26(1): 1-4.
29. 中国营养学会肥胖防控分会, 中国营养学会临床营养分会, 中华预防医学会行为健康分会, 等. 中国居民肥胖防治专家共识. 中国预防医学杂志, 2022, 23(5): 321-339.
30. 《中国高血压防治指南》修订委员会. 中国高血压防治指南(2018年修订版). 中国心血管杂志, 2019, 24(1): 24-56.
31. 孙佳艺, 赵冬, 王薇, 等. 北京地区2 740人的血压水平10年(1992-2002)变化情况. 高血压杂志, 2005, 13(2): 115-119.
32. Tan M, He FJ, Wang C, et al. Twenty-four-hour urinary sodium and potassium excretion in china: a systematic review and meta-analysis. J Am Heart Assoc, 2019, 8(14): e012923.
33. Li Z, Cao L, Zhou Z, et al. Factors influencing the progression from prehypertension to hypertension among Chinese middle-aged and older adults: a 2-year longitudinal study. BMC Public Health, 2023, 23(1): 339.
34. Zhang X, Zhang M, Zhao Z, et al. Geographic variation in prevalence of adult obesity in China: results from the 2013-2014 national chronic disease and risk factor surveillance. Ann Intern Med, 2020, 172(4): 291-293.
35. 房玥晖, 何宇纳, 白国银, 等. 2012年中国20-79岁男性饮酒现状分析. 中华流行病学杂志, 2018, 39(3): 280-285.
36. 《中国居民健康素养监测报告(2018年)》发布. 上海医药, 2019, 40(17): 33.
37. 陈菲. 基于全民健康覆盖的基本公共卫生公平研究. 华中科技大学, 2020.
38. 张艺宏, 王梅, 孙君志, 等. 2014年中国城乡居民超重肥胖流行现状—基于22省(市、区)国家国民体质监测点的形态数据. 成都体育学院学报, 2016, 42(5): 93-100.
39. He J, Ouyang N, Guo X, et al. Effectiveness of a non-physician community health-care provider-led intensive blood pressure intervention versus usual care on cardiovascular disease (CRHCP): an open-label, blinded-endpoint, cluster-randomised trial. Lancet, 2023, 401(10380): 928-938.

Chinese Journal of Evidence-Based Medicine

Study on regional and urban-rural disparities in the hypertension incidence of Chinese adults: based on longitudinal dynamic cohort of CHNS

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