Socio-economic inequalities in hypertension prevalence and care cascade in Bangladesh: Insights from a nationally representative survey.

Authors

Md Abdur Rafi, Urby Saraf Anika, Md Golam Hossain

Published in

PLOS global public health. Volume 6. Issue 6. Pages e0006712. Epub Jun 23, 2026.

Abstract

Hypertension is a leading contributor to non-communicable disease morbidity in Bangladesh. Despite increasing national attention to hypertension control, there remains limited population-level evidence quantifying how inequalities are distributed across the full cascade of diagnosis, treatment, and control using nationally representative data. We aimed to assess socioeconomic inequalities in hypertension prevalence, diagnosis, treatment, and blood pressure control. We analyzed data from the Bangladesh Demographic and Health Survey (BDHS) 2022, including 14,178 adults aged ≥18 years. Hypertension was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or a previous diagnosis. Blood pressure control among treated individuals was defined as systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg at survey measurement. Among participants with hypertension, we examined diagnosis, treatment, and control rates. Multivariable logistic regression estimated adjusted odds ratios (aORs) for factors associated with hypertension prevalence and the care cascade. Socioeconomic inequalities were assessed using the Relative Index of Inequality (RII), Slope Index of Inequality (SII), and Concentration Index (CnI). Overall, 22% of participants had hypertension (3,142/14,178), of whom 59% were previously diagnosed (1,863/3,142); among those diagnosed, 72.5% received treatment (1,350/1,863), and among those treated, 44% achieved blood pressure control (594/1,350). Older age (aOR 12.5, for ≥60 years), female sex (aOR 1.57), being in rich wealth quintile (aOR 1.20,), overweight (aOR 3.41), obesity (aOR 5.45), and type 2 diabetes mellitus (T2DM) (aOR 2.20) were associated with higher odds of hypertension. A pro-rich distribution of socioeconomic inequalities was evident in prevalence (RII 1.74, SII 0.28, CnI 0.09), diagnosis (RII 2.33, SII 0.42, CnI 0.17), treatment (RII 2.56, SII 0.39, CnI 0.15), and control (RII 1.50, SII 0.12, CnI: 0.07) of hypertension. Major gaps and socioeconomic inequalities persist in the hypertension care cascade in Bangladesh. Targeted, equity-focused strategies are essential for improving hypertension care.

PMID:
42335094
Bibliographic data and abstract were imported from PubMed on 24 Jun 2026.

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