Abstract

The Samoan population has experienced rapid increases in the prevalence of non-communicable diseases (NCDs) and NCD risk factors over the last 30 years. However, understanding how increased awareness and treatment of these conditions in reducing disease burden remains understudied. Using data from a longitudinal study (2010–2019) of cardiometabolic health among Samoan adults, we assess the impact of a referral for elevated blood pressure (BP) on changes in BP, physician’s diagnoses of hypertension and medication use, body mass index (BMI), and other risk factors for elevated BP. Analyses compared adult Samoans (n = 328) who in 2010 either (1) received a referral for elevated BP (BP ≥ 140/90 mmHg) or (2) had measured BP indicative of pre-hypertension (BP ≥ 120/80 mmHg) but were not referred. Data were analysed using linear and logistic regression, paired T- and McNemar’s tests, and Wilcoxon Rank Sum assessments. Referrals in 2010 significantly increased the odds of reporting a physician’s diagnosis of hypertension (OR 2.16; 1.18, 3.95) and hypertension medication use (OR 3.52; 1.86, 6.73) in 2018; however, referrals, medication use, and diagnoses were not associated with BP values or reduced odds of having elevated BP. Despite the referral having positive effects on hypertension-related health care, our results demonstrate that other factors are influencing effective BP/hypertension control. We advocate for greater engagement of health researchers with local health sector actors to improve the probability that researcher-provided health referrals will result in long-term health improvements.

摘要

在过去的 30 年中，萨摩亚人口的非传染性疾病 (NCD) 和 NCD 风险因素的患病率迅速增加。然而，了解如何提高对这些疾病的认识和治疗以减少疾病负担仍然没有得到充分研究。使用萨摩亚成年人心脏代谢健康纵向研究（2010-2019）的数据，我们评估了血压升高（BP）转诊对血压变化、医生诊断高血压和药物使用、体重指数（BMI）的影响)，以及其他导致血压升高的危险因素。分析比较成年萨摩亚人 ( n = 328) 他们在 2010 年 (1) 因血压升高 (BP ≥ 140/90 mmHg) 或 (2) 测量了指示高血压前期的血压 (BP ≥ 120/80 mmHg) 但未被转诊。使用线性和逻辑回归、配对 T 和 McNemar 检验以及 Wilcoxon 秩和评估分析数据。2010 年的转诊显着增加了 2018 年医生诊断高血压 (OR 2.16; 1.18, 3.95) 和高血压药物使用 (OR 3.52; 1.86, 6.73) 的几率；然而，转诊、药物使用和诊断与血压值或血压升高的几率降低无关。尽管转诊对高血压相关的医疗保健有积极影响，但我们的结果表明，其他因素正在影响有效的血压/高血压控制。