Korean Circ J.  2019 Jun;49(6):514-527. 10.4070/kcj.2018.0358.

Temporal and Geospatial Trends of Hypertension Management in Korea: a Nationwide Study 2002–2016

Affiliations
  • 1Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea. hckim@yuhs.ac
  • 2Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
  • 3Graduate School, Yonsei University College of Medicine, Seoul, Korea.
  • 4Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
  • 5Big Data Steering Department, National Health Insurance Service, Wonju, Korea.

Abstract

BACKGROUND AND OBJECTIVES
Geographic distribution of hypertension management in Korea has never been reported. We investigated temporal and regional trends of hypertension management in Korea.
METHODS
For each calendar year from 2002 to 2016, we identified 2,423,245 to 7,549,989 persons aged ≥30 years treated for hypertension (total 80,564,109 cases). We calculated yearly age-sex standardized rates for medication adherence, combination therapy, blood test, and urine test according to geographic regions. We then used multivariate logistic regression to calculate odds ratios for hypertension management adjusted for individual-level sociodemographic factors.
RESULTS
Adherence rates have markedly increased from 24.4% (2002) to 71.6% (2016) nationwide. Regional difference was prominent in 2002 (highest, 31.7% in Seoul; lowest, 14.4% in Jeonbuk), but has become less noticeable over 15 years (highest, 73.1% in Daejeon; lowest, 69.0% in Jeonnam, 2016). Combination therapy rates increased from 42.8% (2002) to 61.0% (2011), but are in decreasing trend after 2011. Blood test rates were 58.8% in 2016, whereas urine test rates have been stagnant below 50% across all regions. Geographic variations of combination therapy and complication screening rates were not profound. Results from multivariable logistic regression, adjusted for age and sex, were in agreement with trends observed by standardized rates. The odds ratios remained unchanged when the models were further adjusted for employment status and household income.
CONCLUSIONS
Regional difference in hypertension management was evident in the past, but has become less apparent over the last 15 years in Korea.

Keyword

Hypertension; Medication adherence; Spatio-temporal analysis

MeSH Terms

Employment
Family Characteristics
Hematologic Tests
Humans
Hypertension*
Jeollanam-do
Korea*
Logistic Models
Mass Screening
Medication Adherence
Odds Ratio
Seoul
Spatio-Temporal Analysis

Figure

  • Figure 1 Age-sex standardized rates of hypertension management by regional characteristics and calendar year. All rates (%) are directly age-sex standardized to the 2016 population. (A, B) Adherence rates. (C, D) Combination therapy rates. (E, F) Blood test rates. (G, H) Urine test rates. (A, C, E, G) are stratified into capital or non-capital regions. (B, D, F, H) are stratified into metropolitan, urban, or rural area.

  • Figure 2 Map visualization of hypertension management by geographic region and calendar year. Yearly rates of adherence, combination therapy, blood test, and urine test are directly age-sex standardized to the 2016 population. Fill colors represent rates in percent. Crude and standardized rates in numeric forms are available in Supplementary Tables 3, 4, 5, 6.


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