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

doi:10.5123/S1679-49742019000200018

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

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

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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[TFN8] a) N = N expanded based on observation weights and sample design.

[TFN9] b) %: proportion based on N expanded.

[TFN10] c) 95%CI: 95% confidence interval.

[TFN11] d) McNemar Test significant (p<0.05).

[TFN12] e) Differences in relation to the total are due to lack of information in the variable.

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

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