Accuracy of self-reported systemic arterial hypertension in adults, Rio Branco, Acre, Brazil

Melo, Cleuciane Lima de; Amaral, Thatiana Lameira Maciel; Amaral, Cledir de Araújo; Vasconcellos, Maurício Teixeira Leite de; Monteiro, Gina Torres Rego

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Epidemiologia e Serviços de Saúde

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 28 (2) • 2019 • https://doi.org/10.5123/S1679-49742019000200018 copy

Accuracy of self-reported systemic arterial hypertension in adults, Rio Branco, Acre, Brazil^* * This article is derived from the Master's thesis entitled 'Diagnostic Validation of self-reported systemic arterial hypertension in adults of a municipality in the Brazilian Amazon', defended by Cleuciane Lima de Melo at the Postgraduate Program in Public Health, Federal University of Acre (UFAC) 2016. This study received funding from the National Council for Scientific and Technological Development (CNPq)/Ministry of Science, Technology, Innovation and Communications - MCTI/CNPQ/MS-SCTIE-DECIT No. 06/2013 - intended to support strategic research for the Health System conducted by the Brazilian Network for Health Technology Assessment (REBRATS) - Process No. 401081/2013-3, this study also received funding from the Acre State Research Support Foundation (FAPAC) - PPSUS No. 001/2013 - and from the SUS Research Program: shared health management - MS/CNPq/FAPAC/SESACRE No. 6068-14-0000029.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

to analyze the validity of self-reported systemic arterial hypertension (SAH) in the adult population of Rio Branco, Acre, Brazil.

Methods:

this was a study of diagnostic accuracy with 576 adults aged 18 to 59 years; accuracy, sensitivity, specificity and positive and negative predictive values were calculated in order to build the Receiver Operating Characteristic (ROC) curve.

Results:

the prevalence rates of measured SAH (gold standard) and self-reported SAH were 19.6% and 16.6%, respectively; self-reported SAH showed 53.7% sensitivity and 92.4% specificity; sensitivity ranged from 29.9% in individuals under 40 years of age, to levels above 70.0% among obese individuals and those who reported having dyslipidemia; specificity varied from 70.0% in those who self-reported diabetes mellitus, to 95.3% in underweight patients; the area under the ROC hypertension analysis curve was 0.77 (95%CI 0.72;0.81).

Conclusion:

self-reported SAH in adults 40 years old and over was found to be accurate for use in studies in Rio Branco.

Keywords:
Hypertension; Data Accuracy; Cross-Sectional Studies; Adult; Sensitivity and Specificity; Diagnosis

Variables	Total		Systemic arterial hypertension
	Total		Physically measured				Self-reported
	n	N^a	n	N^a	%^b	IC_95% ^c	n	N^a	%^b	IC_95% ^c
Sex
Male^d	197	101,624	59	22,017	21.7	16.3;28.2	44	15,879	15.6	10.4;22.7
Female	447	110,278	108	19,556	17.7	14.6;21.4	99	19,355	17.6	14.1;21.6
Age group (in years)
18-39	339	146,447	34	15,640	10.7	7.1;15.8	32	13,252	9.0	5.6;14.3
40-59	305	65,455	133	25,933	39.6	39.2;46.8	111	21,981	33.6	26.7;41.2
Ethnicity/skin color
White	120	38,846	37	10,473	27.0	18.4;37.6	30	7,348	18.9	12.0;28.5
Non white	524	173,056	130	31,101	18.0	14.5;22.0	113	27,886	16.1	12.6;20.3
Education Level^e
Middle and higher education	272	96,332	53	14,251	14.8	10.5;20.4	43	10,941	11.4	8.0;15.8
Up to elementary education	358	111,524	113	27,114	24.3	19.2;30.3	97	23,438	21.0	16.3;26.7
Occupation
No	334	96,366	80	15,563	16.2	12.5;20.6	79	16,448	17.1	13.1;22.0
Yes^d	310	115,536	87	26,010	22.5	17.7;28.2	64	18,786	16.3	11.4;22.7
Marital status^e
With a partner	306	98,269	97	24,776	25.2	20.1;31.2	76	20,212	20.6	15.8;26.3
Without a partner	335	112,747	69	16,589	14.7	11.5;18.6	66	14,813	13.1	9.6;17.7
Physical activity^e
Yes	164	70,284	38	11,335	16.1	10.0;25.0	31	9,064	12.9	8.8;18.6
No	477	140,328	127	29,808	21.2	18.1;24.7	110	25,739	18.3	14.2;23.3
Smoking^e
Non-smoker	348	122,593	76	21,484	17.5	13.6;22.2	63	16,696	13.6	10.0;18.3
Smoker or former smoker	292	88,230	91	20,089	22.8	17.5;29.1	79	18,221	20.7	16.1;26.0
Consumption of alcoholic beverages^e
No	463	142,147	128	29,461	20.7	17.2;24.8	112	26,343	18.5	14.8;23.0
Yes	155	60,885	33	9,762	16.0	10.5;23.7	24	7,182	11.8	6.9;19.4
Body mass index (BMI)^e
Underweight (<25Kg/m²)	250	91,213	37	9,579	10.5	6.8;16.0	39	9,189	10.1	6.8;14.6
Overweight (25 to <30Kg/m²)^d	238	75,831	70	17,376	22.9	17.4;29.6	45	10,964	14.5	10.1;20.3
Obese (≥30Kg/m²)	141	39,763	53	13,154	33.1	26.6;40.3	53	14,171	35.6	24.8;48.2
Self-reported stress
No	464	153,855	125	30,643	19.9	16.0;23.4	99	24,844	16.1	12.6;20.5
Yes	160	50,794	37	9,493	18.7	11.9;28.2	41	9,712	19.1	13.1;27.1
Self-reported diabetes^e
No	604	198,959	143	34,869	17.5	14.6;20.9	123	30,611	15.4	12.0;19.4
Yes	33	10,886	20	6,027	55.4	35.1;74.0	16	3,946	36.2	21.2;54.5
Self-reported dyslipidemia^e
No	575	193,580	139	35,173	18.2	15.2;21.4	116	29,451	15.2	11.8;19.3
Yes	56	14,687	24	5,207	35.5	21.2;52.9	26	5,471	37.2	25.1;51.2
Total	644	211,902	167	41,573	19.6	16,5;23,1	143	35,234	16.6	13.2;20.7

Variables	Accuracy	Sensitivity (95% CI)	Specificity (95% CI)	Predictive values
Variables	Accuracy	Sensitivity (95% CI)	Specificity (95% CI)	Positive (95% CI)	Negative (95% CI)
Self-reported SAHb	84.8	53.7 (53.2;54.2)	92.4 (92.3;92.5)	63.3 (61.3;77.2)	89.1 (85.6;91.6)
Sex
Male	84.4	50.0 (49.3;50.6)	93.9 (93.7;94.0)	69.3 (57.5;87.9)	87.2 (81.3;92.8)
Female	85.2	57.8 (57.1;58.5)	91.1 (90.9;91.3)	58.4 (58.8;77.3)	90.9 (85.8;92.6)
Age (in years)
18-39	86.7	29.9 (29.2;30.6)	93.4 (93.3;93.6)	35.3 (13.1;45.0)	91.8 (91.7;97.2)
40-59	80.7	68.0 (67.4;68.6)	89.0 (88.7;89.3)	80.2 (74.2;89.4)	80.9 (73.7;85.6)
Ethnicity/skin color
White	84.3	55.9 (55.0;56.9)	94.7 (94.5;95.0)	79.7 (59.0;91.0)	85.3 (80.7;94.9)
Non white	90.3	52.9 (52.4;53.5)	91.9 (91.8;92.1)	59.0 (58.9;77.1)	89.9 (85.4;92.0)
Marital status
With a partner	79.2	49.4 (48.9;50.2)	89.2 (89.0;89.4)	60.6 (58.7;80.4)	84.0 (78.6;88.9)
Without a partner	86.7	40.7 (40.0;41.5)	94.8 (94.7;95.0)	57.6 (56.6;80.1)	90.3 (89.0;95.6)
Education Level
Up to elementary education	82.2	56.7 (56.1;57.3)	90.4 (90.3;90.6)	65.6 (94.7;95.0)	86.7 (94.7;95.0)
Middle and higher education	87.8	47.2 (46.4;48.1)	94.9 (94.7;95.0)	61.5 (94.7;95.0)	91.2 (94.7;95.0)
Occupation
No	88.4	66.8 (66.0;67.5)	92.5 (92.3;92.7)	63.2 (61.9;82.6)	93.5 (87.1;94.6)
Yes	81.9	45.8 (45.2;46.4)	92.3 (92.2;92.5)	63.5 (53.3;77.7)	85.4 (81.6;90.8)
Practice of physical activity
Yes	84.9	43.2 (42.3;44.1)	92.9 (92.7;93.1)	54.0 (62.1;79.6)	89.5 (85.5;92.3)
No	84.6	57.0 (56.4;57.6)	92.1 (91.9;92.2)	66.0 (44.7;81.2)	88.8 (81.7;93.5)
Smoking
Non-smoker	85.9	48.7 (48.1;49.4)	93.8 (93.7;94.0)	62.7 (40.9;80.8)	89.6 (77.1;91.6)
Smoker and former smoker	83.4	59.0 (58.3;59.7)	90.7 (90.4;90.9)	65.0 (52.9;78.0)	88.2 (86.4;93.8)
Alcoholic beverages consumption
No	84.5	57.4 (56.8;57.9)	91.6 (91.5;91.8)	64.2 (63.9;81.9)	89.2 (85.2;92.1)
Yes	87.7	48.6 (47.6;49.6)	95.2 (95.0;95.4)	66.0 (38.8;75.5)	90.6 (82.7;93.9)
Body mass index (BMI: kg/m²)
Underweight (< 25Kg/m²)	91.1	55.5 (54.5;56.5)	95.3 (95.1;95.4)	57.9 (40.7;77.8)	94.8 (88.4;96.4)
Overweight (25 to <30Kg/m²)	79.7	37.2 (36.5;37.9)	92.3 (92.1;92.5)	59.0 (53.4;81.4)	83.2 (81.1;91.5)
Obese (≥30Kg/m²)	79.7	73.1 (72.4;73.9)	82.9 (82.4;83.4)	67.9 (64.0;86.0)	86.2 (79.4;92.6)
Self-reported stress
No	84.7	52.0 (51.5;52.6)	92.8 (92.6;92.9)	64.2 (61.3;80.0)	88.6 (83.3;90.5)
Yes	86.8	65.8 (64.9;66.8)	91.6 (91.3;91.9)	64.3 (50.7;80.9)	92.1 (89.1;98.2)
Self-reported diabetes
No	86.7	52.6 (52.1;53.1)	93.7 (93.6;93.8)	63.0 (57.9;76.1)	90.6 (86.4;92.3)
Yes	63.3	59.4 (58.2;60.6)	70.0 (68.5;71.5)	76.8 (67.8;100.6)	50.7 (40.0;93.3)
Self-reported dyslipidemia
No	85.4	51.8 (51.3;52.3)	92.9 (92.8;93.0)	61.9 (57.4;75.3)	89.7 (85.6;91.7)
Yes	83.0	78.6 (77.5;79.7)	85.4 (84.7;86.2)	74.8 (72.0;100.0)	87.9 (75.3;100.0)

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[1] Correspondence: Thatiana Lameira Maciel Amaral - BR 364, Km 4, Distrito Industrial, Campus Rio Branco, Rio Branco, Acre, Brasil. CEP: 69920-900. E-mail: thatianalameira27@gmail.com