Sustained effect of health insurance and facility quality improvement on blood pressure in adults with hypertension in Nigeria: A population-based study

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• 作者：Marleen E. Hendriks^a ; ¹ ; ² ; ^{m.hendriks@aighd.org" class="auth_mail" title="E-mail the corresponding author} ; Nicole T.A. Rosendaal^a ; ¹ ; ² ; Ferdinand W.N.M. Wit^a ; ² ; Oladimeji A. Bolarinwa^b ; ² ; Berber Kramer^c ; ^d ; ² ; Danië ; lla Brals^a ; ² ; Emily Gustafsson-Wright^d ; ^e ; ² ; Peju Adenusi^f ; ² ; Lizzy M. Brewster^g ; ² ; Gordon K. Osagbemi^b ; ² ; Tanimola M. Akande^b ; ² ; Constance Schultsz^a ; ²
• 关键词：Health insurance ; Quality of care ; Access to care ; Hypertension ; Nigeria ; Sub-Saharan Africa
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：1 January 2016
• 年：2016
• 卷：202
• 期：Complete
• 页码：477-484
• 全文大小：829 K

文摘

Hypertension is a leading risk factor for death in sub-Saharan Africa. Quality treatment is often not available nor affordable. We assessed the effect of a voluntary health insurance program, including quality improvement of healthcare facilities, on blood pressure (BP) in hypertensive adults in rural Nigeria.

Methods

We compared changes in outcomes from baseline (2009) to midline (2011) and endline (2013) between non-pregnant hypertensive adults in the insurance program area (PA) and a control area (CA), through household surveys. The primary outcome was the difference between the PA and CA in change in BP, using difference-in-differences analysis.

Results

Of 1500 eligible households, 1450 (96.7%) participated, including 559 (20.8%) hypertensive individuals, of which 332 (59.4%) had follow-up data. Insurance coverage increased from 0% at baseline to 41.8% at endline in the PA and remained under 1% in the CA. The PA showed a 4.97 mm Hg (95% CI: − 0.76 to + 10.71 mm Hg) greater decrease in systolic BP and a 1.81 mm Hg (− 1.06 to + 4.68 mm Hg) greater decrease in diastolic BP from baseline to endline compared to the CA. Respondents with stage 2 hypertension showed an 11.43 mm Hg (95% CI: 1.62 to 21.23 mm Hg) greater reduction in systolic BP and 3.15 mm Hg (− 1.22 to + 7.53 mm Hg) greater reduction in diastolic BP in the PA compared to the CA. Attrition did not affect the results.

Conclusion

Access to improved quality healthcare through an insurance program in rural Nigeria was associated with a significant longer-term reduction in systolic BP in subjects with moderate or severe hypertension.