title: Hypertension Prevalence, Awareness, Treatment, and Control Following China's Healthcare Reform.
abstract: BACKGROUND
  In 2009, China started an impressive national healthcare system reform. One of the key components is to promote equity in access to essential healthcare services including chronic disease management. We assessed the changes in hypertension management and its equity before and after China's healthcare reform in 2009.
  
  
  METHODS
  We used data from the 2008 and 2012 waves of the China Health and Retirement Longitudinal Study (CHARLS). The surveys were conducted in Zhejiang and Gansu provinces, containing 1,961 and 1,836 respondents aged 45 and older in 2008 and 2012 respectively. We measured the prevalence of hypertension, and proportions of respondents with hypertension aware of their conditions, receiving treatment and under effective control, separately for 2008 and 2012. We also reported these measures in provinces and rural/urban areas.
  
  
  RESULTS
  From 2008 to 2012, the age standardized prevalence of hypertension was steady at 46.2%, but hypertension management improved substantially. Among those with hypertension, the proportion of patients aware of their conditions increased from 57.8% to 69.9%, the proportion of patients receiving treatment increased from 38.1% to 56.1%, and the proportion of patients with hypertension under effective control increased from 21.7% to 36.4%. The highest improvement was found in rural areas of the underdeveloped province, which indicated that the inequity across regions declined over time.
  
  
  CONCLUSIONS
  Among Chinese population aged 45 and older in Zhejiang and Gansu provinces, hypertension management improved following healthcare reform. The rate of improvement was faster in rural and underdeveloped areas, possibly related to additional governmental subsidies to these areas.
authors.affiliation: Department of Social Medicine, School of Public Health, National Key Laboratory of Health Technology Assessment (Ministry of Health), Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China; zyhou@fudan.edu.cn.
authors.forename: Zhiyuan
authors.initials: Z
authors.lastname: Hou
authors.affiliation: China Center for Health Development Studies, Peking University, Beijing, China;
authors.forename: Qingyue
authors.initials: Q
authors.lastname: Meng
authors.affiliation: Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Yuting
authors.initials: Y
authors.lastname: Zhang
mesh_terms: D017677:Age Distribution; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002681:China / Q000453:epidemiology; D005260:Female; D018166:Health Care Reform / Q000331:legislation & jurisprudence*; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence; D054625:Healthcare Disparities / Q000331:legislation & jurisprudence; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000503:physiopathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012423:Rural Health / Q000331:legislation & jurisprudence; D013997:Time Factors; D016896:Treatment Outcome; D014504:Urban Health / Q000331:legislation & jurisprudence
chemical_list: D000959:Antihypertensive Agents
keywords: China; blood pressure; equity; healthcare reform; hypertension; public health.