Abstract
BACKGROUND: Epidemiological data on ischemic heart disease (IHD) in individuals with hypertension in Thailand are limited. We examined national trends and factors associated with IHD among individuals with hypertension in Thailand from 2011 to 2018, following a decade of universal health coverage (UHC) implementation. METHODS: We conducted a repeated cross-sectional study using data from the Thailand DM/HT study. This study included 226,420 Thai people aged ≥20 years with hypertension who received outpatient care nationwide. The annual prevalence and incidence of IHD were estimated. Modified Poisson regression analysis identified associated factors. RESULTS: Across the 2011-2018 cycles, the age- and sex-adjusted IHD prevalence decreased from 56.6 to 34.5 per 1,000 people (p-trend < 0.001), and the incidence decreased from 9.8 to 4.0 per 1,000 people (p-trend < 0.001). This pattern was observed in both sexes. Men had a higher IHD incidence than women (adjusted risk ratio [aRR]: 1.32; 95% confidence interval [CI]: 1.12-1.56). IHD risk increased with age. Sex modified the effect of age on IHD incidence. Priests were at a higher risk of IHD than agriculturists (aRR: 2.45; 95% CI: 1.46-4.10). IHD incidence was higher in the Central (aRR: 1.49; 95% CI: 1.13-1.96) and Southern (aRR: 1.48; 95% CI: 1.04-2.10) regions than in the Northeast. IHD risk varied based on healthcare coverage scheme and treatment location. Individuals with comorbidities such as diabetes (aRR: 1.20; 95% CI: 1.01-1.43) and chronic kidney disease (aRR: 1.52; 95% CI: 1.30-1.79) had an increased IHD risk. CONCLUSION: After a decade of UHC implementation, Thailand witnessed a reduction in IHD prevalence and incidence among individuals with hypertension from 2011 to 2018. Nevertheless, further opportunities exist to mitigate the IHD risk within this population. Policymakers can use this evidence to prioritize efforts toward reducing the risk of IHD in individuals with hypertension.