Gender Disparity In Awareness and Disease Control among

Indonesia Hypertension Adults Aged ൒40: Study from Indonesia

Family Life Survey Wave 5

Novi Maulina

1Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia

Keywords: Hypertension, Gender Disparity.

Abstract: Hypertension is a known major avoidable risk factor for cerebro- and cardiovascular disease. Awareness of

the disease is required for medication adherence to prevent the complication. Using a cross-sectional

population-based survey data (Indonesia Family Life Survey (IFLS)), we observed the determinant factors

in hypertension awareness and disease control among Indonesia Hypertension adults aged ≥40 (N=2676).

Our finding suggested that 56% of 2676 hypertensive patients were women. Among those patients, only

42.8 % aware that they had high blood pressure and only 14.6 % had the anti-hypertensive drugs. Women

were more aware of hypertension and disease control compared than men. Men and older patients (>60

years old) were more vulnerable to have undiagnosed and untreated hypertensive status. It is substantial to

do regular health screening and society education to improve hypertension awareness and to reduce gender

disparity in cardiovascular problem among Indonesian adults.

1 INTRODUCTION

Hypertension is an important public health issue

since it is a major avoidable risk factor for cerebro-

and cardiovascular diseases, and kidney failure in

Indonesia as one of a low- and middle-income

country (WHO, 2014; Castillo, 2016; Perkovic,

2007). Despite decades of public education efforts to

get lower community-blood pressure, the disease

prevalence remains high due to various factors

affected, such as sociodemographic (older age,

female or male gender, lower education level and

lower household income), geolocality (urban

residence), body size, health behaviour and

psychosocial stress (Ezzati, 2015; Kearney, 2004;

Pereira, 2009). Increasing elder population,

unfavourable behavioural risk factor, low patient

awareness and their adherence to treatment are some

of its challenges (Ong, 2007; Daughterty, 2011).

Precise prevention and treatment strategy is required

to reduce hypertension-related complications and

mortality (Daughterty, 2011).

The management and control of hypertension is

also affected by sex, age and other various factors

(Daughterty, 2011; Sanberg, 2012; Chu, 2015).

However, a study showed that only two-thirds of

adults and the elderly aware of their hypertension

status and gender is known as one of important

factor (Chu, 2015). Determining gender patterns in

hypertension awareness and factors which affect

these patterns in life stage is critical to improve

hypertensive control and reduce cardiovascular

disease risk. In this study, using national-based

survey source, we aimed to investigate sex

difference in hypertension awareness and control

among Indonesian adults aged ≥40 years.

Be advised that papers in a technically unsuitable

form will be returned for retyping. After returned the

manuscript must be appropriately modified.

2 METHODS

2.1 Study Population

We used data from the “Indonesia Family Life

Survey (IFLS-5)”, a sustaining demographic and

health survey that started in 1993 and had four

rounds of data collection, with the fifth wave (IFLS-

5) having been completed in 2015. The surveys

Maulina, N.

Gender Disparity In Awareness and Disease Control among Indonesia Hypertension Adults Aged 40: Study from Indonesia Family Life Survey Wave 5.

DOI: 10.5220/0008789201090113

In Proceedings of the 2nd Syiah Kuala International Conference on Medicine and Health Sciences (SKIC-MHS 2018), pages 109-113

ISBN: 978-989-758-438-1

109

collected data on individual, household and

community level using a multistage stratified

sampling. The original sampling frame of the first

survey in 1993 was based on households from 13 of

27 provinces in Indonesia, which represented

approximately 84% of the Indonesian population in

1993. The detail description of the sampling and

survey methods has been explained elsewhere

(Strauss, 2016).

Randomly selected household members were

asked to provide detailed individual information. In

the IFLS-5, 16,204 households and 29,965 18 years

and older individuals were interviewed and had

complete blood pressure measurements. In the fifth

wave of IFLS, the recontact rate is 92% and for

individual target households, the recontact rate is

90.5% (Strauss, 2016). The survey run

longitudinally and we restricted the data for

participants aged ≥40 years.

In this study, we sorted and filtered the data to

participants aged ≥40 years who had high blood

pressure measurements (systolic blood pressure

≥140 mmHg and diastolic blood pressure ≥90

mmHg) and complete information on other

sociodemographic, body size, self-reported

hypertension and information about medication.

Participants who had not complete information were

excluded.

2.2 Measurement

Measurement included in this study were blood

pressure measurements, anthropometric

measurements, and questionnaire items on

sociodemographic factors and tobacco use.

2.2.1 Blood Pressure Measurement

Systolic and diastolic blood pressure was

measured three times with an Omron meter, HEM-

3204, by regular trained interviewers on household

members 18 years and older at home in a seated

position. The first BP measurement was derived at

the beginning of the interview and subsequent

assessments derived during the interview (Strauss,

2016). The three BP measurements were recorded

and the average BP was then calculated. Blood

pressure was classified using JNC 7 algorithm,

where “Hypertension was defined as systolic BP

≥140 mm Hg and/or DBP ≥90 mm Hg and/or

current use of antihypertensive medication”, while

normotension was defined as BP values <120/80

mm Hg in individuals who were not taking

antihypertensive medication” (Chobanian, 2003).

Aware of being hypertensive was defined if the

participants answered yes of having been diagnosed

of hypertension by a doctor, nurse, paramedic, and

trained mid-wife. Good control of hypertension was

defined if participants responded yes of currently

taking prescribed medication on a weekly basis to

manage hypertension.

The analysis is limited to participants who had

information on hypertension measurement,

awareness, and medication. Participants with

hypertension were defined if they had mean SBP

≥140 mmHg and or mean DBP ≥90 mmHg. Those

hypertensive participants then classified as aware (or

not) and are they on hypertensive medication (or

not).

2.2.2 Anthropometric Measurements

Weights were measured using a Camry model

EB1004 scale and height were measured using a

Seca plastic height board (Strauss, 2016). Body mass

index (BMI) was calculated as weight in kg divided

by height in metre squared and classified according

to Asian criteria: Underweight (BMI <18.5kg/m2),

normal weight (18.5 to 24.9 kg/m2), overweight

(25.0 to 29.9 kg/m2) and obese (BMI ≥30.0 kg/m2)

(Wen CP, 2009). Waist and hip measurement were

measured using a tape and the results was then

recorded to the nearest 0.1 cm. Waist-hip ratio then

calculated by dividing waist to hip measurement.

The WH value >0.9 for man and >0.85 for woman

were then classified as having central obese (Wen

CP, 2009).

2.2.3 Sociodemographic Factors

Sociodemographic data was sourced by list of

questionnaire about sex, age, smoking experience

(ever smoked or not), residential area (urban or

rural), highest level of education (unschooled, grade

school (elementary level), high school (junior or

senior high school) and graduate or above).

2.3 Statistical Analysis

Participants with complete information on blood

pressure measurement and other factors were

included in the analysis. The outcome variables were

mean SBP and DBP, prevalence of hypertension

awareness and disease control. Among hypertensive

patients, the percentage of those aware or not, and

on medication or not, were estimated. Percentage of

factors contributed to gender differences were also

SKIC-MHS 2018 - The 2nd Syiah Kuala International Conference on Medicine and Health Sciences

110

observed. Differences between the groups were

tested using Chi-Square test to observe the

proportion of each factors included. P-value to be

included were set at 0.05. SPSS software version

23.0 were used to analyse the data.

3 RESULT AND DISCUSSION

We sorted and filtered 29,965 total participants aged

≥18 years who had blood pressure measurement to

participants aged ≥40 years who had high blood

pressure (systolic blood pressure ≥140 mmHg and

diastolic blood pressure ≥90 mmHg) and had

complete information on other sociodemographic,

body size, self-reported hypertension and

information about medication. Then we derived

2,893 hypertensive participants aged ≥40 years, but

213 had not complete information and finally 2,676

participants included.

Table 1: Sample Characteristics

Men (%) Women (%)

Age group 44 56

40-49 37.8 36.3

50-59 36.7 36.3

60-69 18.5 18

≥70 6.9 9.3

Body Mass Index

(BMI)

Underweight 5.3 5.1

Normal 50.1 37.4

Overweight 34.7 39.5

Obese 9.9 18

Waist-Hip Ratio

(>0.9 for men and

>0.85 for women)

40.1 59.8

Residence Area

Urban 61 57.7

Rural 38.9 42.3

Education

Unschooled 4.2 14.9

Grade School 41.1 56.1

High School 40.4 23.3

Graduate or above 14.2 5.7

Smoking Experience

Ever 74.6 6.4

Never 25.4 93.6

Of this 2,676 hypertensive participants, we

found that 56% of these hypertensive patients were

women. Women had higher percentage of being

overweight and obese (57.7%), higher waist-hip

ratio (59.8%) and most of them (71%) had lower

education level, compare to men group. It was

consistent with other study in US, that in later life

(>60 years), women had higher risk of being

hypertensive compared to men in the same age

group (Yang Y, 2012). This suggested that in

Indonesia, while women have longer life

expectancy, older women had poorer health than

men. Thus, extending women’s health needs across

the life course beyond reproductive health should be

taken into account.

Among those hypertensive patients, only 42.8

% aware that they had high blood pressure and

women were significantly higher than men patients

(65%, p-value <0.05). Only 14.6 % of the total

sample had the anti-hypertensive drugs, and women

were also significantly higher in men (68%, p-value

<0.05). This result indicates that women had good

awareness of their health condition compared to

men. Other works in US showed that men was more

aware of their hypertension status compared to

women (Guo et al., 2012). The small percentage of

patients who aware of their high blood pressure

could be due to the method we used in collecting

data. In this study, we collected objective measures

of systolic and diastolic blood pressure

(hypertensive patients), followed by self-reported

hypertension, because we thought that the only self-

reported morbidities in general without objective

measurement is a known potential problem in

measuring population health status (Zajacova et al.,

2010).

Schema 1. Prevalence of Awareness and Control of

Hypertensive patients

In our data, respondents aged <60 years old

tend to be more aware of their hypertensive status

(69%) because they more likely to see physicians on

a regular basis, increasing the likelihood that they

2,676

Hypertensive

Patients

1,146 Aware

Hypertension

265 Patients

Medication

Gender Disparity In Awareness and Disease Control among Indonesia Hypertension Adults Aged 40: Study from Indonesia Family Life

Survey Wave 5

111

will get the accurate and up-to-date knowledge of

their blood pressure status.

Both men and women patients (aged >60 years)

had low levels of hypertension awareness and

treatment control compared to those younger

patients aged 40-59 years (31% vs 65%; p-value

<0.05). Body status and education level were

significantly different between men and women in

those who aware. However, area of residence was

not significantly different in awareness and disease

control.

Table 2. Hypertension Characteristic of Study Sample

Men (%) Women (%) p-

value

Aware of

Hypertensi

401 (34) 745

(65)

<0.05

Age Range

40-59 276 (24) 523

(45)

>60 125 (10) 222

(19)

BMI

(Overweight

& obese)

223

(55.8)

418

(56.8)

<0.05

Residence

Area

(Urban)

248

(61.8)

452

(60.7)

0.70

Education

Level (High

School &

graduate)

223

(51.8)

214

(28.9)

<0.05

Control of

Hypertensi

125 (31) 265

(68)

<0.05

Age Range

40-59 83 (31) 172

(65)

>60 42 (15)

93 (35)

Observed gender disparity in health, typically

in hypertension, is due to both biological (sex

hormones, chromosomal differences, and other

biological differences) and behavioural factors

(high BMI, smoking, physical activity) (Sandberg

and Ji, 2012). Our result showed that women had

higher BMI and waist-hip ratio, since men had

smoking a lot compared to women. The wide range

of this behaviour might be closely related to

Indonesia’s culture, where smoking is considered

forbidden for women but a symbol of masculinity

and bravery for men, socially. Higher percentage of

women with lower education could also be related to

lower socioeconomic status, which limit their access

to employment and curtail opportunities for

practicing healthy lifestyle.

The study described the gender and age proportion

in Indonesia adults with hypertensive status, and the

difference of predicting factors for awareness and

disease control, among men and women. The study

did not asses the biological factors or diet habits,

which may alter the results. This study focused on

the gender differences in hypertension, the

importance of universal health screening access and

society education to be delivered to both men and

women.

4 CONCLUSIONS

In our study, hypertensive women patients were

more than men, and they also had good awareness of

high blood pressure and the disease control. Men

and those of older age patients (>60 years old) were

more vulnerable to have undiagnosed and untreated

hypertensive status. It is substantial to do regular

health screening and society education to improve

hypertension awareness and to reduce gender

disparity in cardiovascular problem among

Indonesian adults.

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