O45 INDIVIDUAL VS. HEALTH SYSTEM FACTORS IN HYPERTENSION CONTROL PERFORMANCE: DISTRICT-LEVEL CARE CASCADE ANALYSIS

Background: High-quality health systems are crucial for achieving optimal health outcomes, particularly in managing chronic conditions like hypertension. Effective hypertension control reduces the risk of cardiovascular diseases (CVD). This study examines the relative importance of individual factors (social determinants of health, SDOH) versus health system factors in influencing the stages of the hypertension care cascade in Indonesia, focusing on the controlled rate as the endpoint. This study aims to analyze which factors impact the hypertension care cascade. Methods: The performance of 514 districts in Indonesia was analyzed using multivariate regression. Dependent variables included the percentages of individuals ever tested, diagnosed, treated, and controlled for hypertension. Independent variables encompassed healthcare resource availability, socioeconomic factors, and demographic factors. Results: The regression analysis revealed several key findings: The physician ratio positively and significantly impacted all stages of the care cascade, with coefficients increasing from 0.087 in testing to control 0.356 (p<0.01 for all). The midwife ratio positively influenced testing (0.072), diagnosis (0.135), and treatment (0.160) but not control (0.016, p>0.1). Conversely, Average years of schooling positively correlated with testing (0.111, p<0.05). GNI PPP per capita was positively associated with testing (0.235, p<0.01), diagnosis (0.189, p<0.05), and treatment (0.228, p<0.05), but not control (-0.253, p>0.1). Median age showed a strong positive association across all stages, with coefficients of 1.212 for testing, 1.443 for diagnosis, 1.509 for treatment, and 1.274 for control (p<0.01 for all). Regression shows a pattern that while individual SDOH significantly influenced the early stages of the care cascade (testing and diagnosis), these factors had minimal impact on the control rate. Instead, health system performance was particularly critical for achieving control. Conclusion: Individual SDOHs are more influential in the early stages of the care cascade, while health system factors are crucial for controlling hypertension. Efforts to improve hypertension management should focus on enhancing health system resources to achieve better control rates and reduce CVD risks.