Does home-based screening improve hypertension diagnosis, treatment and control? A regression discontinuity analysis in urban India
As part of India’s efforts to expand primary healthcare services, several state governments are implementing or considering home-based hypertension screening programmes to improve population-wide diagnosis and blood pressure (BP) control rates. However, there is limited evidence on the effectiveness...
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BMJ Publishing Group
2025-06-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/10/6/e017167.full |
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| author | Viswanathan Mohan Dorairaj Prabhakaran Nikhil Tandon K M Venkat Narayan Pascal Geldsetzer Nikkil Sudharsanan Mohammed K Ali Harsha Thirumurthy Shivani A Patel Michaela Theilmann Sneha Sarah Mani |
| author_facet | Viswanathan Mohan Dorairaj Prabhakaran Nikhil Tandon K M Venkat Narayan Pascal Geldsetzer Nikkil Sudharsanan Mohammed K Ali Harsha Thirumurthy Shivani A Patel Michaela Theilmann Sneha Sarah Mani |
| author_sort | Viswanathan Mohan |
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| description | As part of India’s efforts to expand primary healthcare services, several state governments are implementing or considering home-based hypertension screening programmes to improve population-wide diagnosis and blood pressure (BP) control rates. However, there is limited evidence on the effectiveness of home-based screening programmes in India. Using six waves of population-representative cohort data (N=15574), we estimate the causal effect of a home-based hypertension screening intervention on diagnosis, treatment, and BP using a novel application of the Regression Discontinuity Design. We find that measuring individuals’ BP in their homes and providing health information and a referral to those with elevated BP did not meaningfully improve hypertension diagnosis (0.12 percentage points (pp), 95% CI −1.39 to 1.75), treatment (−0.16 pp, 95% CI −2.18 to 1.03), or change in BP (systolic: −0.96mm Hg, 95% CI −5.63 to 1.14; diastolic: 0.21, 95% CI −1.65 to 1.65). Our heterogeneity analyses suggest that home-based screening may reduce systolic BP for women with secondary education and women living in Chennai. However, we find null effects for diagnosis and treatment among these subpopulations and in all outcome variables across the other subpopulations and alternative specifications. Our findings suggest that a lack of knowledge of one’s hypertension status might not be the primary reason for low diagnosis and treatment rates in India, where other structural and behavioural barriers may be more relevant. Adapting screening efforts to address these additional barriers will be essential for India’s efforts to achieve universal health coverage. |
| format | Article |
| id | doaj-art-ab40a0cbb8c349c1872ffb3442ba65dd |
| institution | Kabale University |
| issn | 2059-7908 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Global Health |
| spelling | doaj-art-ab40a0cbb8c349c1872ffb3442ba65dd2025-08-20T03:45:34ZengBMJ Publishing GroupBMJ Global Health2059-79082025-06-0110610.1136/bmjgh-2024-017167Does home-based screening improve hypertension diagnosis, treatment and control? A regression discontinuity analysis in urban IndiaViswanathan Mohan0Dorairaj Prabhakaran1Nikhil Tandon2K M Venkat Narayan3Pascal Geldsetzer4Nikkil Sudharsanan5Mohammed K Ali6Harsha Thirumurthy7Shivani A Patel8Michaela Theilmann9Sneha Sarah Mani10Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, IndiaCentre for Chronic Disease Control, New Delhi, IndiaDepartment of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, Delhi, IndiaEmory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University, Atlanta, Georgia, USADivision of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California, USATUM School of Medicine and Health, Technical University of Munich, Munich, GermanyEmory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University, Atlanta, Georgia, USAPerelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USAEmory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University, Atlanta, Georgia, USABrigham and Women`s Hospital, Harvard Medical School, Boston, MA, USADepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USAAs part of India’s efforts to expand primary healthcare services, several state governments are implementing or considering home-based hypertension screening programmes to improve population-wide diagnosis and blood pressure (BP) control rates. However, there is limited evidence on the effectiveness of home-based screening programmes in India. Using six waves of population-representative cohort data (N=15574), we estimate the causal effect of a home-based hypertension screening intervention on diagnosis, treatment, and BP using a novel application of the Regression Discontinuity Design. We find that measuring individuals’ BP in their homes and providing health information and a referral to those with elevated BP did not meaningfully improve hypertension diagnosis (0.12 percentage points (pp), 95% CI −1.39 to 1.75), treatment (−0.16 pp, 95% CI −2.18 to 1.03), or change in BP (systolic: −0.96mm Hg, 95% CI −5.63 to 1.14; diastolic: 0.21, 95% CI −1.65 to 1.65). Our heterogeneity analyses suggest that home-based screening may reduce systolic BP for women with secondary education and women living in Chennai. However, we find null effects for diagnosis and treatment among these subpopulations and in all outcome variables across the other subpopulations and alternative specifications. Our findings suggest that a lack of knowledge of one’s hypertension status might not be the primary reason for low diagnosis and treatment rates in India, where other structural and behavioural barriers may be more relevant. Adapting screening efforts to address these additional barriers will be essential for India’s efforts to achieve universal health coverage.https://gh.bmj.com/content/10/6/e017167.full |
| spellingShingle | Viswanathan Mohan Dorairaj Prabhakaran Nikhil Tandon K M Venkat Narayan Pascal Geldsetzer Nikkil Sudharsanan Mohammed K Ali Harsha Thirumurthy Shivani A Patel Michaela Theilmann Sneha Sarah Mani Does home-based screening improve hypertension diagnosis, treatment and control? A regression discontinuity analysis in urban India BMJ Global Health |
| title | Does home-based screening improve hypertension diagnosis, treatment and control? A regression discontinuity analysis in urban India |
| title_full | Does home-based screening improve hypertension diagnosis, treatment and control? A regression discontinuity analysis in urban India |
| title_fullStr | Does home-based screening improve hypertension diagnosis, treatment and control? A regression discontinuity analysis in urban India |
| title_full_unstemmed | Does home-based screening improve hypertension diagnosis, treatment and control? A regression discontinuity analysis in urban India |
| title_short | Does home-based screening improve hypertension diagnosis, treatment and control? A regression discontinuity analysis in urban India |
| title_sort | does home based screening improve hypertension diagnosis treatment and control a regression discontinuity analysis in urban india |
| url | https://gh.bmj.com/content/10/6/e017167.full |
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