Abstract
Hypertension is one of the chronic diseases that threaten the health of the elderly population. This study aims to explore the treatment and medication preferences in Chinese elderly patients (≥45 years old) with hypertension, and to investigate the relevant influencing factors. A cross-sectional design was adopted. Utilizing the data from the public database CHARLS 2018, the factors influencing the treatment and medication preference among the elderly hypertensive patients were explored with multinomial logistic regression models. A total of 6588 hypertensive patients aged ≥ 45 years were included in this study, of which 5135 (77.94%) received treatment. Besides, 4939 (96.18%) chose oral medication, which was the most preferred treatment for these patients. The proportion of patients who chose “oral medication only” increased with age, but decreased with educational level and self-reported health. Patients with higher educational levels were more likely to choose other modalities of treatment. In particular, patients with better self-reported health were more willing to try traditional Chinese medication (TCM). Lower income group without medical insurance preferred to choose “Chinese medicine only.” Patients aged ≥ 75 years, urban residents, and those with 2 or more chronic diseases were more willing to try combined Chinese and Western medicines. Patients’ preference for TCM therapy was correlated positively with the provincial economic welfare factor, and negatively with the provincial medical and social welfare factors. During treatment of patients with hypertension, clinicians should pay attention to their preferences and formulate personalized regimens for them, in order to improve their compliance with treatment. Additionally, the government should steadily improve the local medical benefits, thereby facilitating the promotion and application of local TCM services.
Keywords: China, elderly, hypertension, medication preferences, treatment preferences
1. Introduction
Hypertension is a condition in which the pressure in blood vessels continues to rise. As a disease where blood pressure is maintained at excessively high levels, it is characterized by elevated arterial pressure and is accompanied by multiple complications like stroke,[1] coronary heart disease,[2] hemangioma and renal failure.[3] Currently, the World Health Organization defines hypertension as 3 occasional blood pressure measurements on different days of ≥140 mm Hg and/or 90 mm Hg.[4]
According to the latest report of the World Health Organization, globally, over 1 billion people suffer from hypertension, which is the leading cause of premature death, especially in the low- and middle-income countries.[4] Extant data from the China Health Database reveals that the proportion of hypertensive people showed a significant upward trend in China between 2012 and 2018, with middle-aged and elderly population being the high-risk groups. Among them, 40% of the middle-aged people (45–59 years) suffer from hypertension, and 60% of the elderly people (≥60 years) suffer from hypertension.[5] Hence, hypertension is already one of the chronic diseases that threaten the elderly health. In the context of aging, hypertension treatment should be emphasized for the elderly people, which greatly facilitates their life quality improvement.[6]
Hypertension treatments can be classified into the medication and non-medication treatments.[7] With oral medication, western antihypertensives are used more commonly, including thiazide diuretic, angiotensin converting enzyme inhibitor, beta blocker, and long-acting calcium channel blocker.[8] Chinese herbal medicines are also somewhat efficacious in treating hypertension,[9] such as Sihogayonggolmoryeo-Tang[10] and Shenqi pill.[11] Non-medication treatments, on the other hand, mainly advocate lifestyle improvements (e.g., weight loss, smoking cessation, alcohol restriction, and low-salt diet), which also include surgical treatment.
Given the wide variety of treatment methods and drugs, hypertensive patients can make independent choices in addition to following the doctors’ advice. For example, pregnant women in Canada have different demands for treating gestational hypertension. Most of them prefer to make the final treatment decision by themselves (70%), of whom 48% expect a doctor to be involved in decision-making.[12] Additionally, according to the Intercontinental Marketing Services report in 2010, about 40% of Chinese hypertensive patients took dihydropyridine calcium channel blocker for antihypertensive treatment.[13] Factors influencing patients’ choice of treatments include gender, age, educational level, medical knowledge and ethnicity.[12,14] For example, about 1/3 of people in China’s Chengdu are willing to choose renal denervation (RDN) therapy for blood pressure control, and these patients are usually young, more often male who take many antihypertensives and have metabolic disorders.[14] However, extant researches on the preference of hypertension treatments mostly investigate the patients’ willingness to choose a specific monotherapy (such as RDN),[15] while differences in patients’ willingness to choose combined therapy have rarely been compared.
Additionally, although many scholars have investigated the preference of Chinese medication over the whole population, there are scarce studies on the preference and influencing factors of Chinese medicine for managing hypertension. For instance, Chung et al[16] found that 3.17% of patients only visit Chinese medicine department when choosing Chinese and Western medicine outpatient services, and those with chronic diseases are more inclined to use Chinese medicine alone as they grow older. Although Rochelle et al[17] discovered that age, gender and educational level were associated with the residents’ use of Chinese medicine, they failed to specifically analyze the choice of Chinese and Western medications among hypertensive patients. Only a few scholars have researched the usage preference and influencing factors of Chinese and Western medicines for hypertension. For instance, in a survey on the use of Chinese and Western medicines in Heilongjiang’s rural areas, Li et al[18] found that hypertensive patients with higher level of education or better quality of life were more likely to use Chinese medicines for treatment, and no patients in their survey used Chinese herbal drugs and Western medicines concurrently for the control blood pressure.
In summary, there lacks comparative studies concerning patients’ willingness to choose multiple antihypertensive therapies at present, and more studies should be conducted on the preference between Chinese and Western medications for the hypertensive population. Hence, this work investigates the choice of antihypertensive therapies and the preference between Chinese and Western medications among the middle-aged and elderly hypertensive patients, with the focus on analyzing relevant influencing factors, in order to provide reference for the formulation of personalized therapeutic regimes.
2. Methods
2.1. Study design and data
Adopting a cross-sectional design, this study investigated the preferences of therapeutic options and Chinese and Western medications among the middle-aged and elderly Chinese hypertensive patients, as well as relevant influencing factors. Initially, based on preliminary literature review, multiple types of variables were employed as the potential influencing factors (independent variables), including Andersen’s behavioral model-related variables (gender, age, income, etc.), lifestyle variables and provincial-level socioeconomic welfare variables. Next, we categorized the treatment methods of middle-aged and elderly hypertensive patients into 3 types: oral medication only, treatments other than oral medication, and oral medication + other treatments. Then, factors influencing the choice of treatment for elderly hypertensive patients were explored by a multinomial logistic regression. Finally, we separately analyzed the preferences of Chinese and Western medicines in hypertensive patients treated with oral medication, and divided them into 3 types: oral Western medication only, oral Chinese medication only, and concurrent oral Chinese + Western medications. Also, factors influencing the preference of Chinese and Western medications in elderly hypertensive patients were explored by a multinomial logistic regression. Figure 1 illustrates the detailed process.
Figure 1.
Sampling flowchart of hypertension data from CHARLS 2018.
The data in this study comes from the public database—CHARLS (China Health and Retirement Longitudinal Study) 2018 (http://charls.pku.edu.cn/en/). The CHARLS National Baseline Survey was launched in 2011 and, later, follow-up survey was conducted once every 2 to 3 years. It aims to collect high-quality microdata on middle-aged and elderly individuals aged ≥ 45 years and their families in China, with a view to analyzing China’s population aging problem. The survey covers 150 county-level and 450 village-level units in China, with samples already covering a total of 19,000 respondents in 12,400 households. The CHARLS data are published publicly and have been extensively used and recognized in the academic community. Details of CHARLS can be found in literatures.[19,20]
2.2. Research variables and measures
2.2.1. Treatment and medication modalities (dependent variables).
We gradually screened the subjects of CHARLS2018 according to the relevant questionnaire questions. As shown in Figure 1, there are 5 screening steps.
Step 1. Enrolling people aged ≥ 45 years: After deleting 256 people aged < 45 years from the CHARLS2018 database, which included a total of 19,816 subjects, we obtained 19,560 individuals aged ≥ 45 years.
Step 2. Enrolling people with complete variable information: After deleting 5626 individuals with missing information such as independent or dependent variables, 13,934 subjects with complete variable information were obtained.
Step 3. Enrolling people with hypertension: According to the question “Have you been diagnosed with Hypertension by a doctor?” in the questionnaire, we divided the subjects into those with hypertension (N = 6588) and those without hypertension (N = 7346).
Step 4. Classifying hypertensive patients by treatment modality: According to the 4 options of multiple-choice question “Are you now taking any of the following treatments to treat or control your hypertension? Taking Chinese traditional medicine; Taking Western modern medicine; Other treatments; None of the above,” we divided the hypertensive patients into 4 types. The first type was the population who only received other treatments (choosing option 3 only, N = 196); the second type was the population who only received oral medication (choosing option 1 or 2 only, N = 4724); the third type was the population who received other treatments + oral medication concurrently (choosing option 3 + option 1 or 2, N = 215); the fourth type was the population without receiving treatment (choosing option 4 only, N = 1222). Among them, the first, second and third types constituted the treatment methods of hypertensive patients—the first dependent variable in this study.
Step 5. Classifying hypertensive patients receiving oral medication by medicine type: Similarly, according to the options 1 and 2 of the above question, hypertensive patients receiving oral medication were classified into those only taking Western medicine (choosing option 2 only, N = 4300), those only taking Chinese medicine (choosing option 1 only, N = 268), and those taking both Chinese and Western medicines (choosing options 1 + 2, N = 371). Such Chinese and Western medicine preferences of hypertensive patients constituted the second dependent variable of this study.
2.2.2. Independent variables.
First of all, the core variables of this study were selected from Andersen’s behavioral model-related variables,[21] including the predisposing, enabling and demand factors, which have been widely used in many studies on health services. In the case of the present study, the predisposing factors comprised age, gender, marital status, hukou, educational level and degree of satisfaction with local medical services. Among them, hukou is the information registered by individuals according to the type of residence. In China, every person can only register 1 hukou, either urban or rural. Enabling factors comprised personal income, health insurance and pensions, whereas demand factors comprised self-reported health and number of chronic diseases. In addition, personal lifestyle is an important direction of health intervention apart from genetic factors, since human health is affected by multiple types of factors.[22] Hence, we included the lifestyle variables (e.g. smoking and drinking).
Secondly, the provincial-level socioeconomic welfare variables were included. Research has shown that social context, such as socioeconomic welfare, can impact people’s use of health services.[23] An article analyzed the association between provincial-level socioeconomic welfare and depression among the Chinese elderly using the 2018 CHARLS data.[24] In this paper, principal component analysis was used to extract 3 socioeconomic welfare factors constructed from the 14 provincial-level variables which were extracted from the China Civil Affairs Statistical Yearbook for 28 provinces (the same provinces as the CHARLS study). The 3 socioeconomic welfare factors were named economic welfare, social welfare and medical welfare, and were publicly published in the above article. So in our current study, they were used as independent variables.
2.3. Statistical analysis
Initially, current preferences of treatment modalities and medications among the middle-aged and elderly hypertensive patients were descriptively analyzed. Then, χ2 test was employed to compare the inter-group distribution differences in the preferences of treatment modalities and medications. Next, we tested the multicollinearity among the independent variables, and the results showed that the variance inflation factors were all less than 10, indicating absence of collinearity among the independent variables.[25] Finally, factors influencing the treatment and medication preferences of middle-aged and elderly hypertensive patients were explored separately through the multinomial logistic regression.
All statistical tests were two-sided and P values of <.05 were considered statistically significant. The statistical software used was STATA ver. 14.0 (STATA Corp, College Station, TX).
3. Results
A total of 6588 middle-aged and elderly patients with hypertension were included in this study, of which 5135 (77.94%) received treatment. Most of the individuals receiving treatment were females (53.98%), 60 to 74 years of age (53.79%), married (82.49%), rural (74.88%), and had elementary school education (43.14%).
3.1. Treatment preferences of middle-aged and elderly hypertensive patients
Among the 5135 middle-aged and elderly hypertensive patients receiving treatment in this study, 196 (3.82%) received other treatments only, 4724 (92%) received oral medication only, and 215 (4.18%) received multiple treatments (oral medication + other treatments). Oral medication was the first-choice treatment for these patients.
Table 1 describes the distribution of treatment modalities among various influencing factors. Compared to the female and rural hukou patients, the male (4.70%) and urban hukou patients (4.73%) chose other treatments more frequently. The proportion of patients receiving oral medication alone increased with age, but decreased with educational level and self-reported health. Patients with higher levels of education were more prone to choose other treatment modalities. Additionally, compared to the nonsmokers and nondrinkers, less smokers (91.40%) and drinkers (90.21%) chose oral medication only. Instead, more smokers (5.07%) and drinkers (5.72%) chose other treatment modalities.
Table 1.
Distribution of treatment of hypertension among elder Chinese, 2018 (N, %).
| Factors | Other treatments-only | Medication-only | Medication and other treatments | P value† |
|---|---|---|---|---|
| Sex | ||||
| Male | 111 (4.70) | 2155 (91.20) | 97 (4.10) | .010* |
| Female | 85 (3.07) | 2569 (92.68) | 118 (4.26) | |
| Age group | ||||
| 45–59 | 94 (6.06) | 1389 (89.50) | 69 (4.45) | <.001*** |
| 60–74 | 81 (2.93) | 2563 (92.80) | 118 (4.27) | |
| 75+ | 21 (2.56) | 772 (94.03) | 28 (3.41) | |
| Marital status | ||||
| Married | 171 (4.04) | 3884 (91.69) | 181 (4.27) | .154 |
| Others‡ | 25 (2.78) | 840 (93.44) | 34 (3.78) | |
| Hukou | ||||
| Rural resident | 135 (3.51) | 3559 (92.56) | 151 (3.93) | .034* |
| Urban resident | 61 (4.73) | 1165 (90.31) | 64 (4.96) | |
| Education | ||||
| No formal | 22 (1.76) | 1163 (93.26) | 62 (4.97) | |
| Elementary school | 75 (3.39) | 2065 (93.23) | 75 (3.39) | <.001*** |
| Middle school | 60 (5.76) | 945 (90.78) | 36 (3.46) | |
| High School and above | 39 (6.17) | 551 (87.18) | 42 (6.65) | |
| Income | ||||
| Low | 58 (3.74) | 1424 (91.87) | 68 (4.39) | |
| Middle | 56 (2.89) | 1805 (92.99) | 80 (4.12) | .027* |
| High | 82 (4.99) | 1495 (90.94) | 67 (4.08) | |
| Pension | ||||
| No | 24 (4.59) | 481 (91.97) | 18 (3.44) | .431 |
| Yes | 172 (3.73) | 4243 (92.00) | 197 (4.27) | |
| Health insurance | ||||
| No | 4 (3.45) | 107 (92.24) | 5 (4.31) | .977 |
| Yes | 192 (3.83) | 4617 (91.99) | 210 (4.18) | |
| Self-reported general health status | ||||
| Bad | 45 (2.30) | 1817 (92.85) | 95 (4.85) | |
| Fair | 106 (4.40) | 2208 (91.66) | 95 (3.94) | <.001*** |
| Very good/good | 45 (5.85) | 699 (90.90) | 25 (3.25) | |
| Smoke | ||||
| No | 137 (3.45) | 3661 (92.17) | 174 (4.38) | .020* |
| Yes | 59 (5.07) | 1063 (91.40) | 41 (3.53) | |
| Alcohol drinking | ||||
| No | 109 (3.02) | 3351 (92.75) | 153 (4.23) | <.001*** |
| Yes | 87 (5.72) | 1373 (90.21) | 62 (4.07) | |
| Satisfaction with local medical services | ||||
| Dissatisfaction | 38 (4.28) | 816 (92.00) | 33 (3.72) | |
| Neutrality | 99 (4.38) | 2070 (91.55) | 92 (4.07) | .120 |
| Satisfaction | 59 (2.97) | 1838 (92.50) | 90 (4.53) | |
| Chronic illness | ||||
| One chronic disease | 35 (5.06) | 635 (91.76) | 22 (3.18) | .075 |
| Two chronic diseases and more | 161 (3.62) | 4089 (92.03) | 193 (4.34) | |
| Economic welfare§ | 196 (3.82) | 4724 (92.00) | 215 (4.18) | |
| Medical welfare§ | 196 (3.82) | 4724 (92.00) | 215 (4.18) | |
| Social welfare§ | 196 (3.82) | 4724 (92.00) | 215 (4.18) | |
P for Chi test: *P < .05, **P < .01, ***P < .00ṅ.
Include divorced, separated, widowed and single.
Source from the article of Li W, et al (see Reference [24] for details).
3.2. Influencing factors of treatment preferences among middle-aged and elderly hypertensive patients
Using “receiving other treatments only” as a reference, a multinomial logistic regression analyzed the factors influencing the treatment choices of middle-aged and elderly hypertensive patients. Table 2 presents the results.
Table 2.
Multivariate logistic regression model for influencing factors of treatment of hypertension among elder Chinese, 2018 (reference category is the other treatments other than medication).
| Factors | Medication-only | Medication and other treatments | ||
|---|---|---|---|---|
| OR (95% CI) | P value† | OR (95% CI) | P value† | |
| Sex | ||||
| Male | reference | reference | ||
| Female | 0.93 (0.64–1.36) | .709 | 0.83 (0.50–1.37) | .461 |
| Age group | ||||
| 45–59 | reference | reference | ||
| 60–74 | 1.87 (1.31–2.67) | .001** | 1.73 (1.06–2.84) | .029* |
| 75+ | 1.93 (1.12–3.34) | .018* | 1.39 (0.67–2.90) | .379 |
| Marital status | ||||
| Married | reference | reference | ||
| Others‡ | 1.04 (0.66–1.64) | .870 | 0.93 (0.51–1.68) | .805 |
| Hukou | ||||
| Rural resident | reference | reference | ||
| Urban resident | 0.96 (0.66–1.40) | .824 | 1.24 (0.73–2.10) | .421 |
| Education | ||||
| No formal | reference | reference | ||
| Elementary school | 0.65 (0.40–1.08) | .099 | 0.43 (0.23–0.80) | .008** |
| Middle school | 0.45 (0.26–0.78) | .005** | 0.30 (0.15–0.62) | .001** |
| High School and above | 0.44 (0.23–0.83) | 0.011* | 0.59 (0.27–1.31) | 0.198 |
| Income | ||||
| Low | reference | reference | ||
| Middle | 0.77 (0.50–1.18) | .227 | 0.75 (0.43–1.31) | .311 |
| High | 0.80 (0.53–1.19) | .269 | 0.67 (0.38–1.20) | .179 |
| Pension | ||||
| No | reference | reference | ||
| Yes | 1.49 (0.94–2.37) | .092 | 1.72 (0.87–3.39) | .116 |
| Health insurance | ||||
| No | reference | reference | ||
| Yes | 1.17 (0.41–3.35) | .764 | 1.09 (0.27–4.35) | .900 |
| Self-reported general health status | ||||
| Bad | reference | reference | ||
| Fair | 0.58 (0.40–0.84) | .004** | 0.49 (0.31–0.78) | .003** |
| Very good/good | 0.45 (0.28–0.71) | .001** | 0.30 (0.16–0.58) | <.001*** |
| Smoke | ||||
| No | reference | reference | ||
| Yes | 0.87 (0.60–1.25) | .456 | 0.69 (0.41–1.16) | .159 |
| Alcohol drinking | ||||
| No | reference | reference | ||
| Yes | 0.66 (0.47–0.94) | .020* | 0.70 (0.43–1.12) | .137 |
| Satisfaction with local medical services | ||||
| Dissatisfaction | reference | reference | ||
| Neutrality | 1.14 (0.77–1.68) | .527 | 1.36 (0.78–2.38) | .275 |
| Satisfaction | 1.49 (0.97–2.29) | .067 | 1.99 (1.11–3.57) | .021* |
| Chronic illness | ||||
| One chronic disease | reference | reference | ||
| Two chronic diseases and more | 1.03 (0.69–1.54) | .889 | 1.19 (0.65–2.17) | .579 |
| Economic welfare§ | 1.34 (1.02–1.77) | .039* | 0.93 (0.63–1.39) | .739 |
| Medical welfare§ | 0.76 (0.63–0.92) | .004** | 0.88 (0.69–1.13) | .330 |
| Social welfare§ | 0.78 (0.66–0.92) | .004** | 0.72 (0.56–0.92) | .010* |
P for logistic regression: *P < .05, **P < .01, ***P < .001.
Include divorced, separated, widowed and single.
Source from the article of Li W, et al (see Reference [24] for details).
Age, educational level and self-reported health constituted the major influencing factors of patients’ treatment choices. Oral medication was included in both the “oral medication only” and “oral medication + other treatments.” Synthesizing the results in Table 2, we found that older patients preferred to add oral medication in their choice of treatment modalities, with ORs all exceeding 1. Contrastively, patients with higher educational level and better self-reported health were less likely to choose oral medication than those with lower educational level and worse self-reported health, with ORs all below 1.
In addition, patients who drink alcohol were less prone to choose “oral medication only” (odds ratio [OR] = 0.66, 95% confidence interval [95% CI]: 0.47–0.94) than the nondrinkers. Patients who were more satisfied with local medical services were more willing to choose “oral medication + other treatments” for hypertension (OR = 1.99, 95% CI: 1.11–3.57).
Socioeconomic welfare is also one of the factors influencing the hypertensive patients’ treatment choices. For example, the preference of “oral medication only” was positively correlated with the provincial economic welfare factor (OR = 1.34, 95% CI: 1.02–1.77), while negatively correlated with the provincial medical and social welfare factors (OR = 0.76, 95% CI: 0.63–0.92; OR = 0.78, 95% CI: 0.66–0.92).
3.3. Basic situation of the preference between Chinese and Western medicines
In patients with hypertension, the number of patients receiving oral medication is 4939 (96.18%). Among them, 4300 people (87.06%) took only Western medicine orally, 268 people (5.43%) took only Chinese medicine orally, and 371 (7.51%) took Chinese and Western medicine orally.
Table 3 presents the preference distribution for Chinese and Western medicines of patients with hypertension. It can be found that male patients (6.57%), patients with other marriage status (7.44%), urban patients (6.27%), and patients without medical insurance (10.71%) prefer “only Chinese medicine.” Patients with middle and high income (middle income: 7.06%; high income: 7.17%) and patients with good health self-evaluation (4.70%) are more inclined to “take Chinese and Western medicines.” In addition, patients with chronic diseases other than hypertension are more willing to try combined Chinese and Western medicines (8.10%).
Table 3.
Distribution of medication of hypertension among elder Chinese, 2018 (N, %).
| Factors | Western medicine-only | Traditional Chinese medicine-only | Integrated traditional and western medicine | P value† |
|---|---|---|---|---|
| Sex | ||||
| Male | 1930 (85.70) | 148 (6.57) | 174 (7.73) | .004** |
| Female | 2370 (88.20) | 120 (4.47) | 197 (7.33) | |
| Age group | ||||
| 45–59 | 1280 (87.79) | 82 (5.62) | 96 (6.58) | |
| 60–74 | 2341 (87.32) | 135 (5.04) | 205 (7.65) | .192 |
| 75+ | 679 (84.88) | 51 (6.38) | 70 (8.75) | |
| Marital status | ||||
| Married | 3558 (87.53) | 203 (4.99) | 304 (7.48) | .014* |
| Others‡ | 742 (84.90) | 65 (7.44) | 67 (7.67) | |
| Hukou | ||||
| Rural resident | 3263 (87.95) | 191 (5.15) | 256 (6.90) | .004** |
| Urban resident | 1037 (84.38) | 77 (6.27) | 115 (9.36) | |
| Education | ||||
| No formal | 1071 (87.43) | 56 (4.57) | 98 (8.00) | |
| Elementary school | 1862 (87.01) | 127 (5.93) | 151 (7.06) | .631 |
| Middle school | 853 (86.95) | 55 (5.61) | 73 (7.44) | |
| High School and above | 514 (86.68) | 30 (5.06) | 49 (8.26) | |
| Income | ||||
| Low | 1275 (85.46) | 91 (6.10) | 126 (8.45) | |
| Middle | 1671 (88.65) | 81 (4.30) | 133 (7.06) | .031* |
| High | 1354 (86.68) | 96 (6.15) | 112 (7.17) | |
| Pension | ||||
| No | 421 (84.37) | 35 (7.01) | 43 (8.62) | .139 |
| Yes | 3879 (87.36) | 233 (5.25) | 328 (7.39) | |
| Health insurance | ||||
| No | 90 (80.36) | 12 (10.71) | 10 (8.93) | .033* |
| Yes | 4210 (87.22) | 256 (5.30) | 361 (7.48) | |
| Self-reported general health status | ||||
| Bad | 1650 (86.30) | 83 (4.34) | 179 (9.36) | |
| Fair | 2008 (87.19) | 137 (5.95) | 158 (6.86) | <.001*** |
| Very good/good | 642 (88.67) | 48 (6.63) | 34 (4.70) | |
| Smoke | ||||
| No | 3340 (87.09) | 200 (5.22) | 295 (7.69) | .340 |
| Yes | 960 (86.96) | 68 (6.16) | 76 (6.88) | |
| Alcohol drinking | ||||
| No | 3054 (87.16) | 184 (5.25) | 266 (7.59) | .672 |
| Yes | 1246 (86.83) | 84 (5.85) | 105 (7.32) | |
| Satisfaction with local medical services | ||||
| Dissatisfaction | 720 (84.81) | 55 (6.48) | 74 (8.72) | |
| Neutrality | 1906 (88.16) | 99 (4.58) | 157 (7.26) | .084 |
| Satisfaction | 1674 (86.83) | 114 (5.91) | 140 (7.26) | |
| Chronic illness | ||||
| One chronic disease | 585 (89.04) | 48 (7.31) | 24 (3.65) | <.001*** |
| Two chronic diseases and more | 3715 (86.76) | 220 (5.14) | 347 (8.10) | |
| Economic welfare§ | 4300 (87.06) | 268 (5.43) | 371 (7.51) | |
| Medical welfare§ | 4300 (87.06) | 268 (5.43) | 371 (7.51) | |
| Social welfare§ | 4300 (87.06) | 268 (5.43) | 371 (7.51) | |
P for Chi test: *P < .05, **P < .01, ***P < .001.
Include divorced, separated, widowed and single.
Source from the article of Li W, et al (see Reference [24] for details).
3.4. Influencing factors of preference between Chinese and Western medicines in middle-aged and elderly patients with hypertension
Table 4 shows the influencing factor of preference between Chinese and Western medicines of middle-aged and elderly patients with hypertension. In contrast, female patients and patients who are satisfied with local medical treatment are less likely to choose “only Chinese medicine.” (Female patients: OR = 0.61, 95% CI: 0.44–0.83; patients who are satisfied with local medical treatment: OR = 0.68, 95% CI: 0.48–0.97.) Patients over the age of 75, urban patients, and patients with two or more chronic diseases are more willing to try combined Chinese and Western medicines. (Patients over 75 years old: OR = 1.53, 95% CI: 1.05–2.24; urban patients: OR = 1.48, 95% CI: 1.10–1.99; patients with two or more chronic diseases: or = 1.76, 95% CI: 1.14–2.73).
Table 4.
Multinomial logistic regression model for influencing factors of medication of hypertension among elder Chinese, 2018 (reference category is only taking the western medicine).
| Factors | Traditional Chinese medicine-only | Integrated traditional and western medicine | ||
|---|---|---|---|---|
| OR (95% CI)† | P value† | OR (95% CI)† | P value† | |
| Sex | ||||
| Male | reference | reference | ||
| Female | 0.61 (0.44–0.83) | .002** | 0.83 (0.63–1.09) | .178 |
| Age group | ||||
| 45–59 | reference | reference | ||
| 60–74 | 1.02 (0.74–1.42) | .891 | 1.31 (0.98–1.75) | .070 |
| 75+ | 1.15 (0.75–1.77) | .512 | 1.53 (1.05–2.24) | .026* |
| Marital status | ||||
| Married | reference | reference | ||
| Others‡ | 1.64 (1.19–2.25) | .003** | 0.95 (0.71–1.28) | .734 |
| Hukou | ||||
| Rural resident | reference | reference | ||
| Urban resident | 1.14 (0.81–1.61) | .456 | 1.48 (1.10–1.99) | .010* |
| Education | ||||
| No formal | reference | reference | ||
| Elementary school | 1.16 (0.82–1.65) | .391 | 0.87 (0.65–1.16) | .337 |
| Middle school | 0.99 (0.64–1.54) | .980 | 0.93 (0.65–1.34) | .706 |
| High School and above | 0.81 (0.47–1.39) | .447 | 0.94 (0.61–1.45) | .787 |
| Income | ||||
| Low | reference | reference | ||
| Middle | 0.63 (0.45–0.90) | .011* | 0.72 (0.54–0.96) | .027* |
| High | 1.00 (0.69–1.43) | .983 | 0.71 (0.51–0.99) | .044* |
| Pension | ||||
| No | reference | reference | ||
| Yes | 0.82 (0.55–1.22) | .318 | 0.85 (0.60–1.21) | .367 |
| Health insurance | ||||
| No | reference | reference | ||
| Yes | 0.58 (0.30–1.12) | .103 | 0.88 (0.44–1.75) | .710 |
| Self-reported general health status | ||||
| Bad | reference | reference | ||
| Fair | 1.40 (1.04–1.88) | .025* | 0.80 (0.63–1.01) | .056 |
| Very good/good | 1.41 (0.95–2.10) | .092 | 0.58 (0.39–0.87) | .008** |
| Smoke | ||||
| No | reference | reference | ||
| Yes | 0.91 (0.66–1.26) | .586 | 0.83 (0.62–1.13) | .237 |
| Alcohol drinking | ||||
| No | reference | reference | ||
| Yes | 0.93 (0.69–1.26) | .648 | 1.08 (0.82–1.41) | .598 |
| Satisfaction with local medical services | ||||
| Dissatisfaction | reference | reference | ||
| Neutrality | 0.68 (0.48–0.97) | .031* | 0.91 (0.68–1.22) | .516 |
| Satisfaction | 0.91 (0.65–1.28) | .591 | 0.93 (0.69–1.26) | .636 |
| Chronic illness | ||||
| One chronic disease | reference | reference | ||
| Two chronic diseases and more | 0.74 (0.53–1.05) | .097 | 1.76 (1.14–2.73) | .011* |
| Economic welfare§ | 0.60 (0.45–0.79) | <.001*** | 0.80 (0.64–0.99) | .039* |
| Medical welfare§ | 1.24 (1.06–1.46) | .009** | 1.38 (1.21–1.57) | <.001*** |
| Social welfare§ | 0.85 (0.70–1.02) | .080 | 0.91 (0.79–1.05) | .209 |
P for logistic regression: *P < .05, **P < .01, ***P < .001.
Include divorced, separated, widowed and single.
Source from the article of Li W, et al (see Reference [24] for details).
Both “Chinese medicine only” and “Chinese and Western medicines” contain Chinese medicine. According to the regression results in Table 4, there is a negative correlation between high-income patients and preference for Chinese medicine, with OR less than 1. In other words, patients with higher income are more likely to choose Western medicine over Chinese medicine. Compared to patients with unhealthy self-evaluation, patients who felt generally healthy are more willing to choose “only Chinese medicine.” However, patients who rate themselves as very healthy are not willing to try “combined Chinese and Western medicines.” In response to this, it can be speculated that patients with healthier self-evaluation are more willing to try Chinese medicine, but are unwilling to take Western medicine.
Social and economic welfare also have an impact on preference between Chinese and Western medicines in patients with hypertension to a certain extent. In provinces with great economic welfare, patients are less inclined to choose Chinese medicine, with OR less than 1. In province with great medical welfare, patients tend to choose Chinese medicine, with OR greater than 1.
4. Discussion
With the middle-aged and elderly patients with hypertension, the selection of hypertension treatment and preference between Chinese and Western medicines are explored, and the relevant influencing factors are analyzed. According to the results, oral drugs are still the preferred treatment methods for middle-aged and elderly patients with hypertension, especially oral western drugs. This finding is basically consistent with the existing related research.[26]
4.1. Hypertension treatment methods
According to the findings, patient’s preference for treatment may be related to age. The older patients are, the more likely they are to choose “drug treatment,” which relates to the health status of the elderly and the effectiveness and convenience of treatment. The elderly are a special group. With the increase of age, all organs of human beings gradually become senescent, and the level of cognition, action and health continuously declines.[27] Compared with other treatment methods, such as exercise, dietary intervention, and acupuncture, drug therapy is highly convenient, acceptable, and blood pressure controllable. Moreover, it is not limited by time and space. For patients with drinking habits, they are less inclined to choose drug treatment alone, because alcohol has adverse reactions with a variety of drugs, which leads to reduced therapeutic effect and even interaction.[28] Therefore, this patient group is more willing to choose other treatment methods.
Education level and self -health evaluation are negatively correlated with “only drug treatment.” The higher the education level and self -health evaluation, the less inclined to choosing drug therapy, which is similar to the results of a study in Iran.[29] Long-term use of hypertension drugs can easily lead to some adverse side effects of the elderly.[30,31] Given that patients with high education have better understanding of hypertension and related drugs,[29] and patients with good self-health evaluation have positive predictions on the condition and future physical condition, these patients may want to effectively control their blood pressure with other treatments with few physical side effects.
4.2. Preference between Chinese and Western medicines in hypertension
For preference between Chinese and Western medicines, some studies believed that female patients prefer to use Chinese medicine,[16,32] and some found no associations between gender and preference for Chinese medicine.[18] However, the result shows that male patients prefer to choose “only Chinese medicine,” which is inconsistent with previous research. In addition, patients with good self-health evaluation are found to be more willing to try Chinese medicine than Western medicine, because they think that Chinese medicine has conditioning effects and fewer side effects. According to the health beliefs held by many Chinese people, there is a perception that “Chinese medicine has fewer side effects than Western medicine.”[33,34] Therefore, patients with good self-health evaluation are more willing to choose Chinese medicine. Such patients have to use Western medicine only when they are in really bad health.
Combined Chinese and Western medicines’ effect and safety on hypertension have been confirmed by scholars.[35,36] This study found that patients over 75 years old, urban patients, and patients with two or more chronic diseases are more willing to try combined Chinese and Western medicines. With the increase of age and chronic disease types, the high risk factors of patients with hypertension increase. When serving as a single therapy, Western medicine has limited effect on hypertension. However, combined Chinese and Western medicines have a good antihypertensive effect on hypertension and can stabilize the variability of blood pressure.[37,38] Therefore, older patients with more chronic diseases are more willing to try combined Chinese and Western medicines to enhance the efficacy, which is consistent with the conclusions of other literature.[16] In addition, urban residents are more willing to choose combined Chinese and Western medicines compared to rural residents, which may be related to comprehensive medical service system,[39] popular combined Chinese and Western medicines, and high acceptance of combined treatment.
In this study, the correlation between social welfare factors and preference between Chinese and Western medicines is confirmed. Firstly, there is a negative correlation between economic welfare and preference for Chinese medicine. In addition, preference for Chinese medicine for high-income people is relatively low, which may be because high-income patients are prone to fall into the misunderstanding that “the higher the drug price, the better the curative effect.” By contrast, they tend to pay high prices for first-line western drugs. Because of the psychological trust in the efficacy of drugs, this has psychological treatment advantages.[40] Secondly, there is a positive correlation between medical welfare and preference for Chinese medicine, which is mainly due to the continuous promotion of Chinese medicine related policies, such as incorporating some Chinese medicine treatment drugs into medical insurance,[41] improving the combination of Chinese and Western medicine, and improving the development vitality of the Chinese medicine industry.[42] Provinces with great medical welfare will better implement national policies, thereby promoting the public’s use of Chinese medicine.
4.3. Highlights and shortcomings
The highlights of this paper are as follows. First, this paper supplements the related studies on the treatment methods and preference between Chinese and Western medicines of middle-aged and elderly patients with hypertension. Second, the data adopted comes from national data with rigorous sampling processes, which is highly representative. Third, this paper includes various influencing factors as much as possible in limited questionnaires, such as Anderson model factors and satisfaction factors. In particular, social and economic welfare variables at the provincial level are included in the influencing factors.
Nevertheless, there are some shortcomings in this paper. First, this paper has restrictions on the ability of causal inference as cross-sectional research. Second, there is a lack of questionnaire information. Factors related to the patient’s own disease, such as disease duration and complications, are not taken into account. Third, there is a lack of specific information on alternative treatment modalities, such as RDN, as well as information on the reasons patients with hypertension to select or not select certain treatments and medications. Subsequent studies can incorporate this information to improve the research design.
5. Conclusion
In conclusion, the proportion of male patients and urban patients who choose other treatment methods is relatively high. With age, the tendency to choose drug treatment alone increases. With the improvement of education level and self-reported health, the tendency to choose drug treatment alone decreases. Patients over the age of 75, urban patients, and patients with two or more chronic diseases are more willing to try combined Chinese and Western medicines. Preference for Chinese medicine is negatively related to the province’s economic welfare, but positively related to medical welfare.
In terms of theory, this paper analyzes the treatment methods, medication preferences and influencing factors of middle-aged and elderly patients with hypertension, which not only supplements the current research on the treatment methods of middle-aged and elderly patients with hypertension, but also provides reference for the influencing factors analysis of preference between Chinese and Western medicines in patients with hypertension.
In addition, this paper helps clinicians to understand the treatment methods, medication preferences, and medication trends of patients with hypertension comprehensively and systematically. Individualized medication regimens based on patients’ medication preferences are developed to improve the pertinence, compliance, and effectiveness of hypertension treatment, and to effectively control hypertension. Furthermore, the government should pay more attention on expenditure on medical treatment among lower income group without medical insurance. Also, relevant government departments can put forward policies about Chinese medicine based on patients’ preference between Chinese and Western medicines, thereby further enhancing the popularity and efficiency of hypertension Chinese medicine as well as combined Chinese and Western medicines.
Acknowledgments
We would like to acknowledge the China Health and Retirement Longitudinal Study (CHARLS) team for collecting nationally representative data, and for making the data public. We also thank to Li et al for finishing an excellent study on socioeconomic welfare and making the data publicly published.
Author contributions
Conceptualization: Shangren Qin.
Data curation: Hangjing Zhang, Ye Ding.
Formal analysis: Hangjing Zhang, Ye Ding.
Funding acquisition: Ye Ding, Shangren Qin.
Methodology: Shangren Qin.
Project administration: Shangren Qin.
Resources: Hangjing Zhang, Ye Ding.
Software: Hangjing Zhang, Ye Ding.
Supervision: Shangren Qin.
Writing – original draft: Hangjing Zhang, Ye Ding.
Writing – review & editing: Shangren Qin.
Abbreviations:
- 95% CI
- 95% confidence interval
- OR
- odds ratio
- RDN
- renal denervation
- TCM
- Traditional Chinese medication
HZ and YD contributed equally to this work.
This research was funded by Soft Science Research Program of Zhejiang Province [grant number: 2022C35064], General Project of the Department of Education of Zhejiang Province [grant number: Y202249243],Basic Scientific Research Funds of Department of Education of Zhejiang Province [grant number: KYQN202206] and Hangzhou High Level Talent Special Support Project [grant number: 4265C50622026]. The financial sponsor played no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.
Informed consent was obtained from all subjects involved in the study.
We got data from CHARLS project. Ethical approval for all the CHARLS waves was granted from the Institutional Review Board at Peking University. The IRB approval number for the main household survey, including anthropometrics, is IRB00001052-11015. During the fieldwork, each respondent who agreed to participate in the survey was asked to sign 2 copies of the informed consent, and one copy was kept in the CHARLS office, which was also scanned and saved in PDF format. Four separate consents were obtained: one for the main fieldwork, one for the non-blood biomarkers and one for the taking of the blood samples, and another for storage of blood for future analyses.
The authors have no conflicts of interest to disclose.
The datasets can be download from the website: https://charls.pku.edu.cn/en/.
How to cite this article: Zhang H, Ding Y, Qin S. Preference between Chinese and Western medicines for hypertension treatment: Evidences based on Chinese population aged ≥ 45 years. Medicine 2023;102:46(e36158).
Contributor Information
Hangjing Zhang, Email: 2585910277@qq.com.
Ye Ding, Email: dingye729@126.com.
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