HPT NHMS 2011/DR GK/IPH. 33. 39.2% Known HPT. Summary of Key Findings. 76.3% Treated HPT. 34.8% controlled HPT. All HPT. 32.7% ...
15th NIH SCIENTIFIC CONFERENCE, INCORPORATING THE NHMS AND GATS 12-14 JUNE 2012 HOLIDAY VILLA SUBANG JAYA
The Epidemiology of Hypertension in Malaysia: Current Status Gurpreet K1, Guat Hiong T1, Feisul Mustapha2, Jamaiyah Haniff3, Selvarajah S3, Wan Nazaimoon WM4, Noran N Hairi5
Institute for Public Health Disease Control Division, Ministry of Health, Malaysia 3 Clinical Research Centre, 4 Institute for Medical Research 5 Department of Social and Preventive Medicine, Faculty of Medicine, University Malaya and Julius Centre, University Malaya 1
2
1
OUTLINE
• • • • •
Introduction Objectives Methodology Results Discussion / Conclusion HPT NHMS 2011/DR GK/IPH
2
INTRODUCTION
• Is an established risk factor of cardiovascular disease
• Leading risk factor for mortality, responsible for 13% of deaths globally • Causes around half of all deaths from stroke and heart disease HPT NHMS 2011/DR GK/IPH
3
INTRODUCTION
• Globally, the adult prevalence of hypertension - 26.4% (95% CI 26.0-26.8%) in 2000 - ↑ to 29.2% (95% CI 28.8-29.7) in 2025
HPT NHMS 2011/DR GK/IPH
4
Objective(s) Describe the Epidemiology of hypertension in Malaysia in terms of prevalence and socio-demographic distribution
HPT NHMS 2011/DR GK/IPH
5
Methods
• Cross-sectional nationwide study in 2011 • Two stage stratified sampling • 18,231 adults aged 18 years • Prevalence estimates and 95% Confidence Intervals (CI) were calculated by a method appropriate to the complex sampling design
HPT NHMS 2011/DR GK/IPH
6
Methods –Definitions
• Hypertension undiagnosed.
was
classified
as
known
or
previously
• Known hypertension - previously being told by a health care provider to have hypertension or high blood pressure (BP) • Previously undiagnosed (newly diagnosed) hypertension - not previously being told by a health care provider to have hypertension, but currently measuring an average systolic BP of 140 mmHg and/or diastolic BP of 90 mmHg HPT NHMS 2011/DR GK/IPH
7
Blood Pressure Measurement
•Omron-HEM 907 device
•Sitting position, arm at heart level •2 BP readings , 5 minute interval •Average of two BP readings taken
HPT NHMS 2011/DR GK/IPH
8
Results • The individual response rate was 99.3% 18 years old • The overall prevalence of hypertension - 32.7% (95% CI 31.6 - 33.7) • Known hypertension - 12.8 % (95% CI 12.2-13.5) • Previously undiagnosed hypertension 19.8% (95% CI 19.0-20.7) HPT NHMS 2011/DR GK/IPH
9
Results • The prevalence of overall hypertension was significantly higher among the elderly, Other Bumiputras, no formal education, retirees, lower social income and rural residents compared to the other groups • Males and females had prevalence of about one third HPT NHMS 2011/DR GK/IPH
a
similar
overall
10
Prevalence of Hypertension, ≥ 18 years, 2011, Malaysia
Total HPT - 32.7%
19.8 Normotensive Known HPT
12.8
Newly diagnosed HPT 67.3
HPT NHMS 2011/DR GK/IPH
11
Results
Hypertension, Known and Undiagnosed, ≥ 18 years, 2011
Known HPT 39% Undiagnosed HPT 61%
HPT NHMS 2011/DR GK/IPH
12
Prevalence of Hypertension by Sex, 18 Years, 2011 % 40 35
33.7 31.6 Sig
30 25
21.8
Sig
20
17.8
Female
13.8
15
Male
11.9
10 5
0 All HPT
Known/Aware HPT
HPT NHMS 2011/DR GK/IPH
Undiagnosed HPT
13
Prevalence of Hypertension by Age Groups, 18 Years, 2011 Sig – All
80
74.1
72.8
73.4
39.5
40.8
42.0
68.7
70 61.0
%
60 51.6
50
44.0
35.8
37.9
40 27.0
27.2
30 14.3
20
11.8 8.1
10
9.9
11.3
2.0
3.0
30.0
19.8
17.3
Total HPT
34.7 30.7
32.0
31.3
24.6
11.6 7.4
7.1
1.0
17.9
Undiagnosed
31.0
26.7
24.2
22.2
Known
4.2
0
Age groups HPT NHMS 2011/DR GK/IPH
14
Prevalence of Hypertension by Ethnicity, 18 Years, 2011 % 40 35
36.4 34.0
Sig – All
32.3
30.6
30 23.6
25
18.3
20 15
20.9
20.6
17.9 16.0
13.4
14.0
12.7
12.9
10 4.8
5
0 Malay
All HPT
Chinese
Indians
Known/Aware HPT
Other Bumiputras
Others
Undiagnosed HPT
HPT NHMS 2011/DR GK/IPH
15
Prevalence of Hypertension by Educational Level, 18 years,2011 60
56.3 Sig – All
% 50
46.4
All HPT Known/Aware HPT
40 30
Undiagnosed HPT
29.3
29.6
27.1
26.1 20.4
19.3
20
20.7 13.6
10.3 10
7.1
0 No formal education
Primary education
Secondary education
HPT NHMS 2011/DR GK/IPH
Tertiary education
16
Prevalence of Hypertension by Occupation Status, 18 years, 2011
%
Sig – All
80
72.5
70 60 50 40.0
40.5
40
All HPT
36.0
Known/Aware HPT 32.4
30
24.6
10
23.3
22.7 17.2
17.0
20
Undiagnosed HPT
13.3 7.6
0 Employed
Self-employed
H/W & U/W
HPT NHMS 2011/DR GK/IPH
Retirees
17
Prevalence of Hypertension by Monthly Household Income, 18 years, 2011 %
45
41.6
Sig – All
40 33.8
35
32.3
31.7 29.2
30 25 20
27.7
24.2 21.5
20.0
19.4 17.7
17.4
15
12.4
12.3
12.4
11.5
16.5 11.2
10 5
0 < 1000
1,000 - < 2,000 2,000 - < 3,000 3,000 - < 4,000 4,000 - < 5,000 All HPT
Known/Aware HPT
≥5,000
Undiagnosed HPT
18 HPT NHMS 2011/DR GK/IPH
Prevalence of Hypertension, by Locality, 18 Years, 2011 40 %
37.4
Sig – All
35 30.9
30 25
22.7
18.8
20
Urban
Rural 14.7
15 12.2
10 5 0 All HPT
Known/Aware HPT HPT NHMS 2011/DR GK/IPH
Newly Diagnosed HPT
19
Prevalence of Hypertension by State, 18 Years, 2011 Sig -all
%
50 45 40 35 30 25 20 15 10 5 0
42.9 36.4
29.9
27.9
14.0
40.5
34.1
32.8 22.4
41.1
38.2
24.9
24.0 14.2
28.3 28.7
28.4
16.9
16.9 16.0
11.1
All HPT
19.0 15.1
17.9 11.9
17.2
Known/Aware HPT
29.1
25.9 27.1 22.5
18.0
11.2
26.8
17.4 12.8
11.4
18.8
16.3 10.4
14.6 10.3
15.3 11.8
12.7 9.8
Undiagnosed HPT 20
HPT NHMS 2011/DR GK/IPH
Prevalence of Hypertension by Marital Status, 18 years, 2011 70.0
Sig – All
%
62.9
60.0 50.0 37.0
40.0
33.4 29.5
30.0 20.0
21.9
16.2 13.0
10.0
15.1
3.3
0.0 Single
All HPT
Married
Known/Aware HPT
Widow/widower/divorcee
Undiagnosed HPT
21 HPT NHMS 2011/DR GK/IPH
Treatment and Types of Advice Given By HCP to Known Hypertensives, 18 years 2011 % 90
81.7
76.3
74.2
80 65.6
70 60 50
Yes 34.4
40 23.7
30
No 25.8
18.3
20 10 0 Treatment
Dietary Advice
Weight loss advice
HPT NHMS 2011/DR GK/IPH
Exercise advice
22
Usual Place for Seeking HPT Treatment, 18 years, 2011 %
48.64
50 40
22.57
23.43
30 20
3.18
1.79
10
0.39
0
HPT NHMS 2011/DR GK/IPH
23
Prevalence of Hypertension, ≥ 30 years, 1996-2006 50
%
42.6
45
43.5
40 35
32.9 32.2
32.7
30 25 20
19.8
15 12.8
10 5 0 1996 ≥18 years
2006 ≥30 years
Undiagnosed HPT
HPT NHMS 2011/DR GK/IPH
2011 Known HPT
24
Prevalence of Hypertension by Sex, 18 Years, 2006 & 2011 34 34
33.7 33.3
Sig
% 33
Not Sig
33 32
31.6
32
Female
31.0
31
Male
31 30 30
2006
2011
HPT NHMS 2011/DR GK/IPH
25
Prevalence of Hypertension by Educational Level, 18 years, 2006 & 2011 58.6
50
56.3
Sig
60
Sig
46.4
40.9
40
% 30
29.6 25.7
29.6 19.4
20.7
22.2
20 10 0 2006 No formal education Tertiary education
2011 Primary education Unclassified education
Secondary education
26 HPT NHMS 2011/DR GK/IPH
Prevalence of Hypertension by Monthly Household Income Level, 18 years, 2006 & 2011 47.8
50 45
42.8
40
35.5
35
37.6
33.83
31.7
32.27
29.18
30.2
30
26.6
% 25
2006
20
2011
15 10 5 0 < RM 400
RM 400 - < RM RM 1,000 - RM RM 2,000 - RM 999 1,999 2,999 HPT NHMS 2011/DR GK/IPH
≥ RM 3, 000
27
Prevalence of Hypertension by Locality, 18 Years, 2006 & 2011 40
37.4
36.9
35
30
30.9
29.3
25 Urban
% 20
Rural
15 10 5 0 2006
2011
HPT NHMS 2011/DR GK/IPH
28
Burden of Hypertension in Malaysia: Trends & Projections by 2020 (≥ 18 years) 45
42.5 10,000,000 9,000,000
40
35.8 8,000,000
35
Prevalence (%)
30
32.7
7,000,000
6,267,376 6,000,000
25 5,000,000 20 4,000,000 15
Estimated population
32.2
3,000,000
10
2,000,000
5
1,000,000
0
0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Year Source:Division of Disease Control, MOH Est. population, 2006
Est. population, 2011
Prevalence projection, 2006
HPT NHMS 2011/DR GK/IPH
Prevalence projection, 2011
29
Admissions to MOH Hospitals due to Circulatory Diseases: Projections by 2020 200,000
y = 130995e0.0208x R² = 0.7959
180,000 160,000
144,459
144,900 140,000
130,948
120,000
100,000 80,000 60,000 40,000 20,000 0 2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Source:Division of Disease Control, MOH Circulatory diseases HPT NHMS 2011/DR GK/IPH
Projected, Circulatory diseases
30
Deaths in MOH Hospitals due to Circulatory Diseases: Projections by 2020 20,000 y = 605.97x + 8657.9 R² = 0.9027
18,000
16,000 14,000
12,000 10,000
8,000 6,000
4,000 2,000 0 2005
2006
2007
Source:Division of Disease Control, MOH
2008
2009
2010
2011
2012
2013
2014
Circulatory diseases HPT NHMS 2011/DR GK/IPH
2015
2016
2017
2018
2019
Projected, Circulatory diseases
2020
31
Summary of Key Findings
1 in 8 is a known hypertensive
32 HPT NHMS 2011/DR GK/IPH
Summary of Key Findings All HPT 32.7%
39.2% Known HPT
76.3% Treated HPT
34.8% controlled HPT
HPT NHMS 2011/DR GK/IPH
33
Summary of Key Findings
• Currently, 6,267,376 million individuals ≥ 18 years with hypertension in Malaysia • Projected prevalence of hypertension in 2020 35.8%, with an estimated 7.6 million Malaysians age 18 years and above
HPT NHMS 2011/DR GK/IPH
34
Conclusion & Recommendations • HPT is still an important public health problem in Malaysia and needs to be addressed seriously • Cannot be tackled in isolation, but together with other NCD risk factors
HPT NHMS 2011/DR GK/IPH
35
36