Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Master of Science

Program

Epidemiology and Biostatistics

Supervisor

Ali, Shehzad

2nd Supervisor

Stranges, Saverio

Abstract

Hypertension awareness and control reflect healthcare system efficacy to identify the condition and manage its burden. This thesis aimed to determine the prevalence of undetected and uncontrolled hypertension, and their association with social determinants in middle to older-aged adults. Current literature was reviewed, followed by a cross-sectional analysis of Canadian Longitudinal Study on Aging (CLSA) data. Hypertension prevalence in the cohort was 45.5%, of which 14.7% of hypertensives were undetected and 22% uncontrolled. Multivariable analysis results suggest that younger age and active employment are associated with undetected hypertension, and that older age, males, lower household income, and not graduating high school are associated with uncontrolled hypertension. Both outcomes were also strongly associated with not seeing a physician and not checking blood pressure in the last year. We recommend that future research identify and evaluate policies that are tailored to groups with high rates of undetected and uncontrolled hypertension.

Summary for Lay Audience

Hypertension is a leading cause of disease burden in Canada and worldwide, affecting about 26% of the world’s population and in Canada, is responsible for $13.9 billion dollars in healthcare costs annually (10.2% of healthcare spending). Consequently, awareness and control of the disease is of utmost importance both for the lives of individuals and for our healthcare system. The prevalence of undetected and uncontrolled hypertension reflect the success of our system to identify and manage the disease. This thesis set out to determine how significant the numbers of these conditions were in a middle to older-aged cohort (using data from the Canadian Longitudinal Study on Aging) and how certain sociodemographic characteristics may make one more or less likely to have them. We found that among hypertensive individuals in the cohort, 14.7% were unaware of their condition (i.e., undetected hypertension). Additionally, among hypertensives that were aware of their condition (previously diagnosed by a physician), over a quarter had uncontrolled hypertension (unmanaged or mismanaged). This comes out to mean that just under 37% of hypertensives in this cohort either were not aware of their hypertension or were not able to manage or treat it effectively. Given that hypertension is a disease with such a large prevalence, which was found to be just under 45% in this cohort, these are concerning numbers. Also from our analysis, we found that odds of undetected hypertension amongst individuals with hypertension was higher in individuals that are of younger age, and actively employed. Higher odds of uncontrolled hypertension, amongst individuals aware of their hypertension, was found to be associated with older age, males, those of lower household income, and individuals that did not graduate high school. Another strong association that was found was that not seeing a family physician and not having blood pressure taken in the past 12 months had significantly higher odds of both conditions for members of the cohort. Findings from our research suggest that undetected and uncontrolled hypertension remain a problem, and that interventions tailored to high-risk groups may improve our effectiveness at reducing the burden of hypertension.

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Available for download on Sunday, January 19, 2025

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