Effective coverage of medical treatment for hypertension, diabetes and dyslipidaemia in Japan: An analysis of National Health and Nutrition Surveys 2003–2017

摘要

Objective To examine trends in effective medical treatment coverage for hypertension, diabetes and dyslipidaemia in Japan, using a metric to assess effective coverage of health interventions derived from a health system performance assessment framework. Methods We obtained cross-sectional data for 96,863 individuals aged 40–74 years from the 15 annual Japanese National Health and Nutrition Surveys (2003–2017). We defined treatment need for hypertension, diabetes and dyslipidaemia as biomarkers equal to or greater than diagnostic thresholds or medication use. For individuals needing treatment, we conducted nearest-neighbour matching to estimate treatment effects and effective coverage, defined as the fraction of potential reductions in biomarkers actually achieved in treated individuals by medications. Results The age-standardized prevalence of treatment need for hypertension, diabetes and dyslipidaemia remained around 40%, 7% and 33%, respectively, in 2003–2017. Average treatment effects for those treated in 2013–2017 were 14.8 mmHg (95% confidence interval: 14.2–15.4) for systolic blood pressure, 1.2 percentage points (0.8–1.6) for haemoglobin A1c and 57.9 mg/dl (56.6–59.2) for non-high-density lipoprotein cholesterol. Effective coverage significantly increased between 2003–2007 (hypertension: 48.4% [44.7–52.0], diabetes: 43.8% [35.7–51.8], dyslipidaemia: 86.3% [83.1–89.5]) and 2013–2017 (hypertension: 76.2% [74.2–78.2], diabetes: 74.7% [71.0–78.5], dyslipidaemia: 94.6% [93.3–95.9]). Conclusions Effective coverage of medical treatment for metabolic risk factors has increased. Most of the potential reductions in non-high-density lipoprotein cholesterol have been achieved by statins. Further efforts are necessary to improve the effectiveness of antihypertensive and antidiabetic drugs.