The Epidemiology of Hypertension in Malaysia: Current Status ... [PDF]

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

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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

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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

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Objective(s) Describe the Epidemiology of hypertension in Malaysia in terms of prevalence and socio-demographic distribution


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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


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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

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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


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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

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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

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Prevalence of Hypertension, ≥ 18 years, 2011, Malaysia

Total HPT - 32.7%

19.8 Normotensive Known HPT

12.8

Newly diagnosed HPT 67.3


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Results

Hypertension, Known and Undiagnosed, ≥ 18 years, 2011

Known HPT 39% Undiagnosed HPT 61%


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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


Undiagnosed HPT

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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

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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


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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


Tertiary education

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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


Retirees

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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

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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


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


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


Exercise advice

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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


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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


2011 Known HPT

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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


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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


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

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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


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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


Prevalence projection, 2011

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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

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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

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Summary of Key Findings

1 in 8 is a known hypertensive


Summary of Key Findings All HPT 32.7%

39.2% Known HPT

76.3% Treated HPT

34.8% controlled HPT


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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


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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


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