Socioeconomic inequalities in the prevalence and management of hypertension: analyses of the Chilean National Health Surveys 2003, 2010 and 2017

Background: Up-to-date information on hypertension prevalence and management indicators (awareness, treatment, control); measures of its socioeconomic inequalities; and their impacts are required in Chile. This PhD aims to quantify the prevalence of these indicators, the magnitude of their socioeconomic inequalities, and their association with mortality risk among adults in Chile 2003, 2010, and 2017. Methods: First, using 2003, 2010, and 2017 Chilean national health surveys (ENS) I analysed secular changes in levels of hypertension outcomes by demographic variables. Secondly, I analysed socioeconomic position (SEP) inequalities in hypertension outcomes using individual-level measures (educational level, income, and health insurance). Thirdly, using a multilevel approach, I evaluated the association between individual educational level and hypertension prevalence, before and after adjustment for socioeconomic environment measures (county-level income inequality, poverty, and unemployment). Finally, I analysed all-cause and cardiovascular mortality rates by educational level and hypertension status using ENS data linked with mortality registries. Results: Between 2003 and 2017, hypertension prevalence decreased (34%-31%), awareness increased slightly (58%-66%), whereas treatment (38%-65%) and control (13%-34%) levels increased substantially. Hypertension management levels were lower among males than females. Secondly, hypertension prevalence was higher among adults with lower levels of education. Inequalities by education in hypertension prevalence, untreated, and uncontrolled hypertension were more pronounced among females. Thirdly, multilevel analyses showed that the magnitude of inequalities by education level were minimally affected by socioeconomic environment measures. Finally, I found a higher risk of all-cause and cardiovascular mortality in participants with hypertension and at the lowest educational level. Conclusions: Despite favourable changes in hypertension outcomes over time, Chile currently needs innovative and collaborative strategies to improve hypertension management (especially among males), and simultaneously decrease SEP inequalities in hypertension outcomes (mainly among females). Interventions decreasing hypertension prevalence, improving hypertension management, and increasing educational levels could help to decrease the burden of premature mortality

Sexual and gender minority health in Chile: findings from the 2016–2017 Health Survey

OBJECTIVE: To expose visibility of the health concerns of sexual and gender minority groups in Chile, as well as to provide a platform to advocate for policies that support the health and well-being of SGM people in the country. METHODS: The health conditions and risk factors of participants identified as sexual and gender minority were compared to those identified as cisgender heterosexual using data from the 2016-2017 National Health Survey. RESULTS: Despite reporting higher self-rated health than heterosexual men, gay men had a higher risk of lifetime diagnosis of sexually transmitted infections. Compared to heterosexual women, the prevalence of depression was higher among bisexual women, who were also less likely to have been tested for HIV. Moreover, transgender participants were more likely to report depression and worse self-rated health than cisgender heterosexual participants. CONCLUSION: Small sample sizes of sexual and gender minority subgroups might have obscured some differences that would have been observable in larger samples. Despite this, we found statistically significant sexual and/or gender identity differences in several health areas, especially mental, sexual, and overall health

Tracking health system performance in times of crisis using routine health data: lessons learned from a multicountry consortium

COVID-19 has prompted the use of readily available administrative data to track health system performance in times of crisis and to monitor disruptions in essential healthcare services. In this commentary we describe our experience working with these data and lessons learned across countries. Since April 2020, the Quality Evidence for Health System Transformation (QuEST) network has used administrative data and routine health information systems (RHIS) to assess health system performance during COVID-19 in Chile, Ethiopia, Ghana, Haiti, Lao People's Democratic Republic, Mexico, Nepal, South Africa, Republic of Korea and Thailand. We compiled a large set of indicators related to common health conditions for the purpose of multicountry comparisons. The study compiled 73 indicators. A total of 43% of the indicators compiled pertained to reproductive, maternal, newborn and child health (RMNCH). Only 12% of the indicators were related to hypertension, diabetes or cancer care. We also found few indicators related to mental health services and outcomes within these data systems. Moreover, 72% of the indicators compiled were related to volume of services delivered, 18% to health outcomes and only 10% to the quality of processes of care. While several datasets were complete or near-complete censuses of all health facilities in the country, others excluded some facility types or population groups. In some countries, RHIS did not capture services delivered through non-visit or nonconventional care during COVID-19, such as telemedicine. We propose the following recommendations to improve the analysis of administrative and RHIS data to track health system performance in times of crisis: ensure the scope of health conditions covered is aligned with the burden of disease, increase the number of indicators related to quality of care and health outcomes; incorporate data on nonconventional care such as telehealth; continue improving data quality and expand reporting from private sector facilities; move towards collecting patient-level data through electronic health records to facilitate quality-of-care assessment and equity analyses; implement more resilient and standardized health information technologies; reduce delays and loosen restrictions for researchers to access the data; complement routine data with patient-reported data; and employ mixed methods to better understand the underlying causes of service disruptions

Nutritional and metabolic benefits associated with active and public transport: Results from the Chilean National Health Survey, ENS 2016–2017

Background: Physical inactivity is one of the main risk factors for death worldwide. There is a paucity of studies about the association between transport and objective health measures using nationally representative samples worldwide, especially from Latin American countries. The aim of this research is to explore the relationship between active transportation and objective health measures in Chile. Methods: We analysed the Chilean National Health Survey (ENS) 2016–2017, based on a nationally representative sample of non-institutionalised adults aged ≥15 years (n = 6,113). ENS included anthropometric measures (weight, height, waist circumference), a specific question about the main mode of transportation and several metabolic markers. Results: 41%, 38% and 21% of participants used public transport, motor vehicles and active (cycling and walking) transport respectively. Higher levels of active transport were observed in males, younger groups, less educated and rural populations. Both active and public transport were associated with multiple nutritional and metabolic benefits such as lower BMI, lower waist circumference, less obesity, higher vitamin D, lower cholesterol and lower hepatic inflammation. Associations persisted after adjusting for other healthy lifestyles. Stronger benefits were observed in males than in females. Conclusions: Promoting active transportation in urban planning policies may help Chile tackle the growing burden of chronic diseases

Hypertension care cascade in Chile: a serial cross-sectional study of national health surveys 2003-2010-2017

Background Trend data on hypertension prevalence and attainment indicators at each step of the care cascade (awareness, treatment, control) are required in Chile. This study aims to quantify trends (2003–2017) in prevalence and in the proportion of individuals with hypertension attaining each step of the care cascade among adults aged 17 years or older, and to assess the impact of lowering the blood pressure (BP) thresholds used to define elevated BP on these indicators. Methods We used data from 2003, 2010, and 2017 Chilean national health surveys. Each year we assessed levels of (1) mean systolic (SBP) and diastolic (DBP) blood pressure, (2) hypertension prevalence (BP ≥ 140/90 mmHg or use of antihypertensive treatment), and (3) awareness, treatment, and control. Logistic regression on pooled data was used to assess trends in binary outcomes; linear regression was used to assess trends in continuous SBP and DBP. We compared levels of hypertension prevalence using two sources to ascertain antihypertensive treatment (self-reported versus medicine inventory). The 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines were used to re-define hypertension using lower thresholds (BP ≥ 130/80 mmHg). Results Hypertension prevalence was 34.0, 32.0 and 30.8% in 2003, 2010 and 2017, respectively. Levels of treated- and controlled-hypertension were significantly higher in 2017 than in 2003 (65% versus 41% for treatment, P < 0.001; 34% versus 14% for control, P < 0.001), while levels of awareness were stable (66% versus 59%, P = 0.130). Awareness, treatment, and control levels were higher among females in 2003, 2010, and 2017 (P < 0.001). Mean SBP and DBP decreased over the 15-year period, except for SBP among females on treatment. Adopting the 2017 ACC/AHA guidelines would increase hypertension prevalence by 17 and 55% in absolute and relative terms, respectively. Conclusions Chile has experienced a positive population-wide lowering in blood pressure distribution which may be explained partly by a significant rise in levels of treated- and controlled-hypertension since 2003. Lowering the thresholds used to define elevated BP would substantially increase the financial public health challenge of further improving attainment levels at each step of the care cascade. Innovative and collaborative strategies are needed to improve hypertension management, especially among males

Sexual and gender minority health in Chile: findings from the 2016–2017 Health Survey

ABSTRACT OBJECTIVE To expose visibility of the health concerns of sexual and gender minority groups in Chile, as well as to provide a platform to advocate for policies that support the health and well-being of sexual and gender minority people in the country. METHODS The health conditions and risk factors of participants identified as sexual and gender minority were compared to those identified as cisgender heterosexual using data from the 2016-2017 National Health Survey. RESULTS Despite reporting higher self-rated health than heterosexual men, gay men had a higher risk of lifetime diagnosis of sexually transmitted infections. Compared to heterosexual women, the prevalence of depression was higher among bisexual women, who were also less likely to have been tested for HIV. Moreover, transgender participants were more likely to report depression and worse self-rated health than cisgender heterosexual participants. CONCLUSION Small sample sizes of sexual and gender minority subgroups might have obscured some differences that would have been observable in larger samples. Despite this, we found statistically significant sexual and/or gender identity differences in several health areas, especially mental, sexual, and overall health

Additional file 1 of Associations between the stringency of COVID-19 containment policies and health service disruptions in 10 countries

Additional file 1: Supplemental Table 1. Health services by service type category in 10 countries. Supplemental Table 2. Definition of containment policies and dichotomous recoding. Supplemental Table 3. Results from multi-level linear regression model for the association between the OxCGRT stringency index and relative service volumes (median stringency index). Supplemental Table 4. Results from multi-level linear regression model for the association between the OxCGRT stringency index and relative service volumes (max stringency index)