Equity in the continuum of hypertension care: evidence from a nationally representative survey in Nepal

One in four individuals has hypertension, a major cardiovascular risk factor, with a higher burden among people of low socioeconomic status in Nepal. An equity audit can help identify gaps in the continuum of hypertension care (awareness, treatment and control) to guide the development of a tailored intervention towards the priority population. We analysed data sourced from the Nepal Demographic and Health Survey, 2022. We specifically chose women and men who had hypertension (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or those on treatment). We used the theoretical framework of the Commission on Social Determinants of Health and PROGRESS-Plus criteria to measure inequity among both sexes. Frequency distributions and univariable analysis were used to describe participants’ characteristics. We performed regression-based measures, i.e., the relative concentration index (RCI), to measure the extent to which an indicator is concentrated among disadvantaged or affluent subgroups. A total of 1,033 women (mean age: 54.3 years) and 993 men (52.3 years) were found to be hypertensive. Awareness of hypertension differs substantially by age and educational status among both sexes. Four out of five individuals from a younger age (15–35 years) were unaware of their hypertension status. Wealth was consistently associated with better awareness, treatment and control of hypertension. A fourfold increase (7.1% vs. 29.4%) in the control rates was reported among the richest, compared to those in the poorest wealth quintile in men. Among those in the poorer wealth quintile and with no education, the control rate was found to be 10% vs. 30% for wealthy and highly educated women. The gap was even wider for men (6.1% vs. 38.7%). The RCI established that better awareness and control were concentrated among individuals in the richer wealth quintile, consistent across sexes and across rural and urban. We observed substantial socioeconomic disparity by education and wealth quintile across awareness, treatment and control. An equity-centric community engagement approach is needed to address the current disparity and meaningful involvement of underserved populations.