Associations between social determinants and poor hypertension treatment adherence among middle-aged and older people in rural China: a hospital-based case‒control study

BACKGROUND: Treatment adherence is a major challenge in hypertension management, particularly given the growing aging issue and burden of chronic diseases in China. Middle-aged and older adults with hypertension in rural China face a greater risk of poor adherence because of health care disparities and limited primary care support. This study aimed to determine the factors associated with treatment adherence among middle-aged and older adults with hypertension in rural China. METHODS: A hospital-based case–control study was conducted to gather information among hypertensive patients in Daqiao Town, China. Treatment adherence was assessed using the Hill-Bone Compliance to High Blood Pressure Therapy (HBCHBPT) scale, with cases defined as patients with poor adherence (score < 48) and controls defined as those with good adherence (score ≥ 48). Data were collected using a structured questionnaire, and stepwise logistic regression was used to identify factors associated with poor adherence. RESULTS: A total of 287 patients with hypertension (96 cases and 191 controls) were included. Overall, 56.1% were aged 40–65 years, 48.4% were male, and 54.7% were employed. Poor antihypertensive treatment adherence was significantly associated with being employed (AOR = 4.15, 95% CI = 1.63–10.56), taking ≥ 3 medicines (AOR = 3.67, 95% CI = 1.45–9.30), having ≥ 3 other chronic diseases (AOR = 2.66, 95% CI = 1.18–5.99), infrequent blood pressure measurement (AOR = 3.41, 95% CI = 1.00–11.66), attending follow-up with companions or alone (AOR = 9.79, 95% CI = 4.01–23.90), poor self-rated blood pressure control (AOR = 3.32, 95% CI = 1.12–9.78), insufficient health literacy (AOR = 5.84, 95% CI = 2.60–13.08), low self-efficacy (AOR = 6.11, 95% CI = 2.54–14.67), and low perceived social support (AOR = 6.11, 95% CI = 2.42–13.67). CONCLUSION: Poor adherence reflects the combined effects of treatment complexity, primary health care, and psychosocial factors. Blood pressure monitoring, village doctor home visits, chronic disease management, self-rated blood pressure assessment, and targeted health education with psychosocial support would help to improve long-term adherence.