Socioeconomic disparities in the burden of hypertension among Indonesian adults - a multilevel analysis

Figures & data

Figure 1. Flowchart presenting the selection of respondents in the study.

Figure 2. Age-Standardised prevalence, awareness, treatment, and control of hypertension based on residential areas.

Table 1. Characteristics of the IFLS study participants.

Variables	Urban (N=18,845)		Rural (N=13,189)
	N	%	N	%
Gender
Male	8,807	46.7	6,206	47.1
Female	10,038	53.3	6,983	52.9
Age (years)
15-34	9,156	48.6	6,154	46.7
35-54	6,865	36.4	4,738	35.9
55-74	2,500	13.3	1,932	14.6
>75	324	1.7	365	2.8
Marital status
Unmarried	4,207	22.3	2,066	15.7
Married	13,044	69.2	9,947	75.4
Widowed/divorced	1,594	8.5	1,176	8.9
Education level
No formal education	548	2.9	1,024	7.7
Primary education	4,475	23.8	5,113	38.8
Secondary education	10,563	56.0	6,054	45.9
Higher education	3,259	17.3	998	7.6
Employment
Unemployed	6,221	33.0	3,792	28.8
Employed	12,624	67.0	9,397	71.2
Insurance ownership
No	8,484	45.0	5,349	40.6
Yes	10,361	55.0	7,840	59.4
Wealth index
1^st Quintiles (poorest)	1,964	10.4	3,516	26.7
2^nd Quintiles	3,243	17.2	3,059	23.2
3^rd Quintiles	4,058	21.5	2,520	19.1
4^th Quintiles	4,619	24.5	2,113	16.0
5^th Quintiles (richest)	4,961	26.4	1,981	15.0
BMI (kg/m2)
Underweight (<18.5)	2,226	11.8	1,836	13.9
Normal (18.5–22.9)	7,182	38.1	5,926	44.9
Overweight (23–24.9)	2,968	15.8	1,987	15.1
Obese (>25)	6,469	34.3	3,440	26.1
Smoking status
Non-smokers	12,381	65.7	8,106	61.5
Ex-smokers	936	5.0	589	4.5
Current smokers	5,528	29.3	4,494	34.0

Table 2. Univariate logistic regression of the factors associated with the prevalence, awareness, treatment, and control of hypertension among the adult population in Indonesia.

Variables	Prevalence (N=32,034)	Unaware (N=7,623)	Untreated (N=2,492)	Uncontrolled (N=676)
	OR (95%CI)	OR (95%CI)	OR (95%CI)	OR (95%CI)
Age (years)
15-34	ref.	ref.	ref.	ref.
35-54	4.29 (3.97–4.63)	0.37 (0.31–0.44)	0.64 (0.42–0.99)	2.33 (1.09–4.99)
55-74	12.1 (11.0–13.3)	0.26 (0.22–0.31)	0.43 (0.28–0.66)	4.66 (2.17–10.0)
>75	28.8 (23.9–34.9)	0.31 (0.24–0.40)	0.53 (0.32–0.88)	8.58 (2.67–27.6)
Gender
Female	ref.	ref.	ref.	ref.
Male	0.88 (0.82–0.93)	2.16 (1.95–2.41)	1.20 (0.98–1.47)	0.80 (0.51–1.24)
Marital status
Married	ref.	ref.	ref.	ref.
Unmarried	0.31 (0.28–0.34)	4.02 (2.99–5.40)	1.83 (0.88–3.81)	0.56 (0.14–2.23)
Widow/Divorced	2.94 (2.70–3.21)	0.75 (0.66–0.84)	0.90 (0.73–1.12)	2.83 (1.60–5.00)
Residence
Urban	ref.	ref.	ref.	ref.
Rural	0.91 (0.86–0.97)	1.20 (1.08–1.33)	1.46 (1.19–1.77)	1.76 (1.08–2.87)
Education level
No formal education	3.79 (3.28–4.38)	0.98 (0.78–1.22)	1.60 (1.08–2.37)	7.71 (2.73–21.7)
Primary education	2.07 (1.87–2.29)	0.96 (0.80–1.15)	1.61 (1.17–2.21)	2.00 (1.08–3.71)
Secondary education	0.88 (0.80–0.97)	1.21 (0.99–1.45)	1.32 (0.96–1.83)	1.10 (0.58–2.07)
Higher education	ref.	ref.	ref.	ref.
Employment
Employed	ref.	ref.	ref.	ref.
Unemployed	1.18 (1.11–1.26)	0.53 (0.47–0.59)	0.62 (0.51–0.76)	1.09 (0.70–1.69)
Insurance ownership
Yes	ref.	ref.	ref.	ref.
No	0.96 (0.91–1.02)	1.35 (1.22–1.50)	1.25 (1.04–1.51)	1.33 (0.85–2.10)
Wealth index
1^st Quintiles (poorest)	1.40 (1.27–4.53)	1.56 (1.32–1.85)	2.27 (1.64–3.13)	2.42 (1.09–5.37)
2^nd Quintiles	1.10 (1.00–1.21)	1.23 (1.05–1.46)	1.34 (1.01–1.78)	1.44 (0.76–2.74)
3^rd Quintiles	1.18 (1.08–1.29)	1.21 (1.03–1.42)	1.29 (0.98–1.70)	0.98 (0.55–1.76)
4^th Quintiles	1.04 (0.95–1.13)	1.30 (1.09–1.54)	1.08 (0.82–1.43)	1.15 (0.61–2.17)
5^th Quintiles (richest)	ref.	ref.	ref.	ref.
BMI (kg/m2)
Underweight (BMI<18.5)	0.80 (0.71–0.89)	0.98 (0.79–1.23)	1.10 (0.72–1.69)	1.94 (0.68–5.54)
Normoweight (BMI 18.5–22.9)	ref.	ref.	ref.	ref.
Overweight (BMI 23–24.9)	1.56 (1.42–1.70)	0.78 (0.67–0.92)	0.95 (0.69–1.29)	1.08 (0.57–2.04)
Obese (BMI >25)	2.38 (2.23–2.56)	0.65 (0.58–0.74)	0.85 (0.67–1.08)	1.82 (1.10–3.01)
Smoking status
Non-smokers	ref.	ref.	ref.	ref.
Former smokers	1.94 (1.72–2.19)	0.81 (0.67–0.98)	0.75 (0.56–1.01)	0.70 (0.39–1.23)
Current smokers	0.87 (0.81–0.93)	2.42 (2.12–2.75)	1.94 (1.47–2.57)	1.22 (0.61–2.42)

Table 3. Multilevel analysis of the factors associated with the prevalence, awareness, treatment, and control of hypertension among the adult population in Indonesia.

Variables	Prevalence (N=32,034)	Unaware (N=7,623)	Untreated (N=2,492)	Uncontrolled (N=676)
	OR (95%CI)	OR (95%CI)	OR (95%CI)	OR (95%CI)
Fixed effects
Age (years)
15-34	ref.	ref.	ref.	ref.
35-54	3.41 (3.14–3.71)	0.47 (0.39–0.57)	0.73 (0.49–1.10)	1.93 (0.88–4.25)
55-74	10.5 (9.45–11.6)	0.29 (0.24–0.36)	0.47 (0.30–0.71)	4.10 (1.78–9.44)
>75	23.1 (18.7–28.4)	0.33 (0.25–0.45)	0.65 (0.37–1.15)	4.34 (1.27–14.8)
Gender
Female	ref.	ref.	ref.	ref.
Male	1.57 (1.43–1.72)	1.66 (1.42–1.94)	1.11 (0.82–1.48)	1.30 (0.65–2.57)
Marital status
Married	ref.	ref.	ref.	ref.
Unmarried	1.20 (1.07–1.34)	2.01 (1.50–2.69)	1.50 (0.72–3.09)	0.60 (0.13–2.82)
Widow/Divorced	1.56 (1.41–1.73)	1.05 (0.91–1.21)	1.02 (0.79–1.31)	1.43 (0.79–2.58)
Residence
Urban	ref.	ref.	ref.	ref.
Rural	0.97 (0.89–1.05)	0.99 (0.88–1.13)	1.16 (0.93–1.45)	1.33 (0.82–2.18)
Education level
No formal education	2.22 (1.88–2.61)	1.26 (0.97–1.64)	1.34 (0.84–2.13)	2.47 (0.82–7.49)
Primary education	1.47 (1.31–1.64)	1.05 (0.86–1.29)	1.45 (1.01–2.06)	1.23 (0.62–2.46)
Secondary education	1.07 (0.96–1.18)	1.02 (0.84–1.23)	1.40 (1.00–1.95)	0.81 (0.43–1.52)
Higher education	ref.	ref.	ref.	ref.
Employment
Employed	ref.	ref.	ref.	ref.
Unemployed	1.22 (1.13–1.31)	0.74 (0.65–0.83)	0.68 (0.55–0.84)	0.90 (0.57–1.43)
Insurance ownership
Yes	ref.	ref.	ref.	ref.
No	0.94 (0.89–1.00)	1.32 (1.18–1.46)	1.13 (0.93–1.38)	1.18 (0.75–1.87)
Wealth index
1^st Quintiles (poorest)	1.09 (0.98–1.21)	1.45 (1.21–1.74)	1.85 (1.31–2.60)	1.13 (0.49–2.58)
2^nd Quintiles	1.03 (0.93–1.14)	1.21 (1.02–1.44)	1.12 (0.83–1.51)	1.25 (0.67–2.34)
3^rd Quintiles	1.12 (1.02–1.23)	1.18 (1.00–1.39)	1.34 (1.01–1.77)	0.79 (0.44–1.42)
4^th Quintiles	1.04 (0.95–1.14)	1.28 (1.09–1.51)	1.13 (0.86–1.49)	1.14 (0.63–2.06)
5^th Quintiles (richest)	ref.	ref.	ref.	ref.
BMI (kg/m2)
Underweight (BMI<18.5)	0.61 (0.55–0.69)	1.04 (0.84–1.29)	1.06 (0.70–1.60)	1.43 (0.54–3.77)
Normoweight (BMI 18.5–22.9)	ref.	ref.	ref.	ref.
Overweight (BMI 23–24.9)	1.70 (1.56–1.86)	0.90 (0.77–1.06)	0.98 (0.73–1.32)	1.42 (0.77–2.60)
Obese (BMI >25)	2.94 (2.73–3.17)	0.79 (0.69–0.89)	0.89 (0.70–1.13)	2.35 (1.44–3.83)
Smoking status
Non-smokers	ref.	ref.	ref.	ref.
Former smokers	1.08 (0.94–1.24)	0.70 (0.57–0.87)	0.82 (0.57–1.17)	0.46 (0.21–1.01)
Current smokers	0.84 (0.77–0.92)	1.55 (1.31–1.83)	1.47 (1.05–2.08)	1.02 (0.45–2.31)
Random effects
Community (PSU) random variance (SE^a)	0.075 (0.018)	0.079 (0.023)	0.175 (0.068)	0
Community (PSU) VPC^b (%)	2.2	2.3	5.0	0

^aSE: Standard error, ^b VPC: variance partition coefficient.

Figure 3. Concentration Curves of prevalence, awareness, treatment, and control of hypertension by wealth index among Indonesian adults in urban and rural areas.

Table 4. Concentration Index of prevalence, awareness, treatment, and control of hypertension.

	Concentration Index (95% CI)
	Urban	Rural	Total
Prevalence	−0.047 (−0.069, −0.025)	−0.075 (−0.101, −0.049)	−.0.061 (−0.081, −0.042)
Awareness	0.066 (0.029, 0.103)	0.059 (0.012, 0.107)	0.076 (0.046, 0.107)
Treatment	0.096 (0.030, 0.162)	0.183 (0.087, 0.278)	0.148 (0.094, 0.202)
Control	0.080 (−0.067, 0.227)	0.082 (−0.108, 0.273)	0.090 (−0.021, 0.202)