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18.1% of adults in urban India have hypertension but just 45% of them are diagnosed. India’s official hypertension care guidelines ask clinicians to opportunistically screen patients (e.g. screen for hypertension regardless of what individuals initially sought care for). The poor level of hypertension diagnosis in spite of opportunistic screening guidelines suggests clinicians may not be consistently following screening guidelines. The magnitude of this gap and whether patients can demand improved preventive care from their clinicians is unknown. To address these two important questions, we will conduct a randomized experiment using standardized patients. Standardized patients are individuals carefully recruited and trained to act as real patients that seek actual care; standardized patients are trained to present their conditions to the clinician in a standardized way and remember and convey/document which actions clinicians took during the consultation. Our study will be conducted in approximately 600 primary care clinics in two Indian cities (Chennai and Kolkata) and include both private and public facilities. We will randomize half the standardized patient visits to present a case of back pain with no indication of hypertension (control) and the other half to present a case of a patient requesting a general blood pressure checkup (intervention). We will estimate the share of visits that result in an opportunistic screening using screening information for the control cases. We will then estimate the extent to which patient demand can result in better preventive care by comparing screening rates between the control and intervention standardized patient presentations.

Socioeconomic gaps in life expectancy have widened substantially in the United States since 2000. Yet the contribution of specific causes to these growing disparities remains unknown. We used death records from the National Vital Statistics System and population data from Current Population Surveys to quantify the contribution of alcohol-attributable causes of death to changes in US life expectancy between 2000 and 2018 by sex and socioeconomic status (as measured by educational attainment). During the study period, the gap in life expectancy between people with low (high school diploma or less) compared with high (college degree) levels of education increased by three years among men and five years among women. Between 2000 and 2010 declines in cardiovascular disease mortality among people with high education made major contributions to growing inequalities. In contrast, between 2010 and 2018 deaths from a cause with an alcohol-attributable fraction of 20 percent or more were a dominant driver of socioeconomic divergence. Increased efforts to implement cost-effective alcohol control policies will be essential for reducing health disparities.

Over 82% of adults with diagnosed hypertension in India do not have controlled blood pressure. Regular visits are essential for maintaining medicine consistency and ensuring that blood pressure remains controlled over time; however, recent studies find that over 50% of individuals with hypertension miss these essential visits. The aim of this study is to determine whether simple phone call reminders can meaningfully reduce missed visits among individuals with diagnosed hypertension in Punjab, India. Reminders are a commonly used tool for addressing missed visits but their effectiveness has been mixed across studies; the main contribution of our study will be to combine the phone call reminders with information targeting common misconceptions about hypertension care that may contribute to missed visits beyond low-salience/ forgetfulness (the commonly justified use for reminders) to try and maximize the effect of the reminder.

Over 82% of adults with diagnosed hypertension in India do not have controlled blood pressure. Regular visits are essential for maintaining medicine consistency and ensuring that blood pressure remains controlled over time; however, recent studies find that over 50% of individuals with hypertension miss these essential visits. The aim of this study is to determine whether low-cost reminder messages can meaningfully reduce missed visits among individuals with diagnosed hypertension in Punjab, India. Reminders are a commonly used tool for addressing missed visits but their effectiveness has been mixed across studies; the main contribution of our study will be to tie WhatsApp message reminders with information targeting common misconceptions about hypertension care that may contribute to missed visits beyond low-salience/ forgetfulness (the commonly justified use for reminders) to try and maximize the effect of the message.

BACKGROUND: Improving hypertension control is an important global health priority yet, to our knowledge, there is no direct evidence on the blood pressure (BP)-mortality relationship in sub-Saharan Africa. We investigate the BP-mortality relationship in South Africa and assess the comparative effectiveness of different care targets for clinical care and population-wide hypertension management efforts. METHODS: We use country-wide population-based longitudinal data from five waves (2008 – 2017) of the South African National Income Dynamics Study (N = 4,993). We estimate the relationship between systolic BP (SBP) and six-year all-cause mortality and compare the mortality reductions associated with lowering SBP to different targets. We then estimate the number needed to treat to avert one death (NNT) under different hypothetical population-wide scale up scenarios. FINDINGS: We found a weak, nonlinear, SBP-mortality relationship with larger incremental mortality benefits at higher SBP values: reducing SBP from 160 to 150 mmHg was associated with a mortality risk ratio of 0.95 (95% CI: 0.90, 0.99, p = 0.033), incrementally reducing SBP from 150 to 140 mmHg a risk ratio of 0.96 (95% CI: 0.91, 1.01, p = 0.12), with no evidence of incremental benefits of reducing BP below 140 mmHg. At the population level, reducing SBP to 150 mmHg among all those with an SBP > 150 mmHg had the lowest NNT (50) at 3.3 deaths averted (95% CI: −0.6, 0.3) per 1,000 population while requiring BP management for 16% (95% CI: 15.2, 17.3) of individuals. INTERPRETATION: The SBP-mortality association is weaker in South Africa than in high-income and many low- and middle-income countries. As such, we do not find compelling evidence in support of targets below 140 mmHg and find that scaling up management based on a 150 mmHg target is more efficient in terms of the NNT compared to strategies to reduce SBP to lower values.