Associations between socioeconomic status and adherence to hypertension treatment among older adults in urban and rural areas in Myanmar: a cross-sectional study using baseline data from the JAGES in Myanmar prospective cohort study
Objectives This study aims to investigate whether there is a differential association between socioeconomic status (SES) and adherence to hypertension medication among older adults in rural and urban areas in Myanmar and assess what type of SES is associated with a difference.Design Cross-sectional...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-01-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/1/e065370.full |
| _version_ | 1797950603377246208 |
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| author | Hla Hla Win Takeo Fujiwara Yugo Shobugawa Yuri Sasaki Ikuma Nozaki Daisuke Takagi Yuiko Nagamine Yu Par Khin Yuki Shirakura Lwin Kay Thi Zin Poe Ei Zarchibo Thae |
| author_facet | Hla Hla Win Takeo Fujiwara Yugo Shobugawa Yuri Sasaki Ikuma Nozaki Daisuke Takagi Yuiko Nagamine Yu Par Khin Yuki Shirakura Lwin Kay Thi Zin Poe Ei Zarchibo Thae |
| author_sort | Hla Hla Win |
| collection | DOAJ |
| description | Objectives This study aims to investigate whether there is a differential association between socioeconomic status (SES) and adherence to hypertension medication among older adults in rural and urban areas in Myanmar and assess what type of SES is associated with a difference.Design Cross-sectional study using baseline data from the Japan Gerontological Evaluation Study in Myanmar prospective cohort study. A multistage random sampling method was applied in each region.Setting An urban and a rural area in Myanmar.Participants A total of 1200 older adults over 60 years old in Myanmar were randomly selected in 2018 (600 each from rural and urban areas). Of them, 573 had hypertension and were eligible for the analysis (urban: 317, rural: 256).Outcome Adherence to hypertension medication (yes/no) is the outcome of interest. Three types of SES (wealth, education and current employment status) were the independent variables.Results We found that 21.5% of urban residents and 48.4% of rural residents were non-adherent in the study population. Poisson regression modelling stratified by area was performed to estimate the prevalence ratios (PRs) of not following treatment instructions. Demographic information and complications of hypertension were adjusted for in all models as possible confounders. In terms of SES, middle level of wealth compared with low level was significantly associated with poor adherence (PR 2.68, 95% CI 1.28 to 5.59) in the urban area, but education and employment status did not show similar associations. Lower education compared with middle/high school or higher was significantly associated with poor adherence in the rural area (no school: PR 3.22, 1.37–7.58; monastic: 3.42, 1.16–5.07; primary school: 2.41, 1.18–4.95), but wealth and income did not show similar associations.Conclusions SES and adherence to hypertension medication were differently associated among older adults in rural and urban areas in Myanmar. To ensure healthcare access to hypertension treatment for every citizen, the differential association between SES and adherence in urban/rural areas needs to be recognised. |
| first_indexed | 2024-04-10T22:17:31Z |
| format | Article |
| id | doaj.art-6316e4a0329147b3bcca9c2f523d44f8 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-04-10T22:17:31Z |
| publishDate | 2023-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-6316e4a0329147b3bcca9c2f523d44f82023-01-18T07:00:08ZengBMJ Publishing GroupBMJ Open2044-60552023-01-0113110.1136/bmjopen-2022-065370Associations between socioeconomic status and adherence to hypertension treatment among older adults in urban and rural areas in Myanmar: a cross-sectional study using baseline data from the JAGES in Myanmar prospective cohort studyHla Hla Win0Takeo Fujiwara1Yugo Shobugawa2Yuri Sasaki3Ikuma Nozaki4Daisuke Takagi5Yuiko Nagamine6Yu Par Khin7Yuki Shirakura8Lwin Kay Thi9Zin Poe Ei10Zarchibo Thae113 Department of Preventive and Social Medicine, University of Medicine 1, Yangon, Yangon, The Republic of the Union of MyanmarDepartment of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, JapanExpert Committee on Infection Control and Prevention in Schools, Ministry of Education, Culture, Sports, Science and Technology, Tokyo, Japan7 Department of International Health and Collaboration, National Institute of Public Health, Wako, JapanBureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, JapanDepartment of Health and Social Behavior, Graduate School of Medicine, The University of Tokyo, Tokyo, JapanTokyo Medical and Dental University, Tokyo, JapanDepartment of Global Health Promotion, Tokyo Medical and Dental University, Bunkyo-ku, JapanDepartment of Active Ageing, Niigata University, Niigata, JapanDepartment of Preventive and Social Medicine, University of Medicine, Magway, MyanmarDepartment of Preventive and Social Medicine, University of Medicine 1, Yangon, Yangon, MyanmarDepartment of Preventive and Social Medicine, University of Medicine 1, Yangon, Yangon, MyanmarObjectives This study aims to investigate whether there is a differential association between socioeconomic status (SES) and adherence to hypertension medication among older adults in rural and urban areas in Myanmar and assess what type of SES is associated with a difference.Design Cross-sectional study using baseline data from the Japan Gerontological Evaluation Study in Myanmar prospective cohort study. A multistage random sampling method was applied in each region.Setting An urban and a rural area in Myanmar.Participants A total of 1200 older adults over 60 years old in Myanmar were randomly selected in 2018 (600 each from rural and urban areas). Of them, 573 had hypertension and were eligible for the analysis (urban: 317, rural: 256).Outcome Adherence to hypertension medication (yes/no) is the outcome of interest. Three types of SES (wealth, education and current employment status) were the independent variables.Results We found that 21.5% of urban residents and 48.4% of rural residents were non-adherent in the study population. Poisson regression modelling stratified by area was performed to estimate the prevalence ratios (PRs) of not following treatment instructions. Demographic information and complications of hypertension were adjusted for in all models as possible confounders. In terms of SES, middle level of wealth compared with low level was significantly associated with poor adherence (PR 2.68, 95% CI 1.28 to 5.59) in the urban area, but education and employment status did not show similar associations. Lower education compared with middle/high school or higher was significantly associated with poor adherence in the rural area (no school: PR 3.22, 1.37–7.58; monastic: 3.42, 1.16–5.07; primary school: 2.41, 1.18–4.95), but wealth and income did not show similar associations.Conclusions SES and adherence to hypertension medication were differently associated among older adults in rural and urban areas in Myanmar. To ensure healthcare access to hypertension treatment for every citizen, the differential association between SES and adherence in urban/rural areas needs to be recognised.https://bmjopen.bmj.com/content/13/1/e065370.full |
| spellingShingle | Hla Hla Win Takeo Fujiwara Yugo Shobugawa Yuri Sasaki Ikuma Nozaki Daisuke Takagi Yuiko Nagamine Yu Par Khin Yuki Shirakura Lwin Kay Thi Zin Poe Ei Zarchibo Thae Associations between socioeconomic status and adherence to hypertension treatment among older adults in urban and rural areas in Myanmar: a cross-sectional study using baseline data from the JAGES in Myanmar prospective cohort study BMJ Open |
| title | Associations between socioeconomic status and adherence to hypertension treatment among older adults in urban and rural areas in Myanmar: a cross-sectional study using baseline data from the JAGES in Myanmar prospective cohort study |
| title_full | Associations between socioeconomic status and adherence to hypertension treatment among older adults in urban and rural areas in Myanmar: a cross-sectional study using baseline data from the JAGES in Myanmar prospective cohort study |
| title_fullStr | Associations between socioeconomic status and adherence to hypertension treatment among older adults in urban and rural areas in Myanmar: a cross-sectional study using baseline data from the JAGES in Myanmar prospective cohort study |
| title_full_unstemmed | Associations between socioeconomic status and adherence to hypertension treatment among older adults in urban and rural areas in Myanmar: a cross-sectional study using baseline data from the JAGES in Myanmar prospective cohort study |
| title_short | Associations between socioeconomic status and adherence to hypertension treatment among older adults in urban and rural areas in Myanmar: a cross-sectional study using baseline data from the JAGES in Myanmar prospective cohort study |
| title_sort | associations between socioeconomic status and adherence to hypertension treatment among older adults in urban and rural areas in myanmar a cross sectional study using baseline data from the jages in myanmar prospective cohort study |
| url | https://bmjopen.bmj.com/content/13/1/e065370.full |
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