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evidence: source inventory for hypertension-control-global #41

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28 changes: 21 additions & 7 deletions problem-packs/public-health/hypertension-control-global/datasets.md
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# Dataset Inventory

| Source | Grain | Status | Use |
| ---------------------------- | ------------ | ------ | ------------- |
| Primary survey data | Sub-national | Usable | Core analysis |
| Satellite/environmental data | Variable | Usable | Risk context |
| Population data | 100m | Usable | Denominator |
Dated source inventory for hypertension detection and control gaps in LMICs. Classification reflects fitness for a sub-national detection-treatment-control cascade analysis. Inventory compiled 2026-06-18.

## Sources

| Source | Grain | Measure family | Status | Use |
| ---------------------------------------- | --------------------------------- | --------------------------------------- | -------- | ---------------------------------------------- |
| WHO Global Report on Hypertension (2023) | Global / national | Modeled cascade benchmark | Usable | Global benchmark for diagnosis/control rates |
| NCD-RisC pooled analysis (Lancet 2021) | National, ages 30-79 | Measured-BP cascade by country and sex | Usable | Cross-country comparison backbone |
| WHO STEPS microdata (NCD Microdata Repo) | National; limited sub-national | Measured-BP survey microdata | Usable | Country cascade estimates from raw survey data |
| DHS Program biomarkers | National + georeferenced clusters | Measured-BP prevalence (subset) | Limited | Supplementary prevalence where BP was measured |
| GBD 2021 high systolic BP burden (IHME) | National + some subnational | Modeled attributable burden (DALYs) | Limited | Burden context, not a cascade measurement |
| PURE study (JAMA 2013) | Community cohorts, ages 35-70 | Measured-BP cascade, non-representative | Limited | Historical cross-income comparison only |
| Self-report-only household surveys | Varies | Self-reported diagnosis | Rejected | Underestimates measured prevalence (see below) |

## Classification Reasons

- **Usable** sources provide directly measured blood pressure and a detection/treatment/control cascade at national or finer grain.
- **Limited** sources are usable only for a narrower purpose: DHS BP coverage is survey-specific and cascade items are inconsistent; GBD outputs are attributable burden, not measured control; PURE is non-representative community cohorts from 2003-2009.
- **Rejected**: self-report-only surveys underestimate measured prevalence by ~20% (women) to ~55% (men) per a large Indian comparison study (SSM - Population Health, 2022), so they cannot anchor prevalence or cascade estimates.

## Required Properties

Source methodology, data year, geographic grain, license.
Source methodology, data year, geographic grain, measure family (measured vs self-reported), license, and detection/treatment/control coverage.

## Rejection Rule

Rejected if methodology, grain, date, or license unverifiable.
Rejected if methodology, grain, date, or license is unverifiable, or if hypertension status is self-reported rather than measured.
121 changes: 118 additions & 3 deletions problem-packs/public-health/hypertension-control-global/evidence.json
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"claim": "WHO estimates 1.3 billion adults have hypertension, with only 45 percent diagnosed and 20 percent controlled globally, and control rates below 10 percent in most LMICs.",
"evidence_type": "primary-source",
"source": {
"title": "Global Report on Hypertension",
"url": "https://www.who.int/publications/i/item/9789240081060"
"title": "Global report on hypertension: the race against a silent killer",
"url": "https://iris.who.int/handle/10665/372896"
},
"source_date": "2023-09-19",
"access_date": "2026-06-07",
"access_date": "2026-06-18",
"method": "Reviewed WHO hypertension report, detection and control cascade data.",
"limitations": [
"Diagnosis data depends on survey frequency.",
"Treatment-control data from routine systems is incomplete."
],
"confidence": "high"
},
{
"id": "ncd-risc-hypertension-trends-2021",
"problem_id": "public-health/hypertension-control-global",
"claim": "A pooled analysis of 1201 population-representative studies with measured blood pressure (104 million participants, 184 countries) estimates age-standardized hypertension prevalence, detection, treatment, and control for adults aged 30-79 by country and sex for 1990-2019, and is usable as the cross-country comparison backbone for this pack.",
"evidence_type": "peer-reviewed-study",
"source": {
"title": "Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants",
"url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC8446938/"
},
"source_date": "2021-09-11",
"access_date": "2026-06-18",
"method": "Read the open-access NCD-RisC article and its methods section; confirmed it uses only measured (not self-reported) blood pressure and reports the full detection-treatment-control cascade by country, sex, and year.",
"limitations": [
"Estimates are at national level for ages 30-79 only; the paper does not provide sub-national grain.",
"Where country data are sparse the cascade values are modeled, widening uncertainty for many low-income countries.",
"Cut-off is 2019, so it predates recent program scale-up."
],
"confidence": "high"
},
{
"id": "who-steps-microdata",
"problem_id": "public-health/hypertension-control-global",
"claim": "The WHO NCD Microdata Repository distributes nationally representative STEPS survey microdata with directly measured blood pressure, supporting country-level detection, treatment, and control estimates and limited sub-national breakdowns where sample design allows.",
"evidence_type": "dataset",
"source": {
"title": "WHO NCD Microdata Repository — STEPS collection",
"url": "https://extranet.who.int/ncdsmicrodata/index.php/collections/STEPS"
},
"source_date": "2024-01-01",
"access_date": "2026-06-18",
"method": "Opened the STEPS collection in the WHO NCD Microdata Repository and confirmed it lists country STEPS datasets with measured blood pressure variables and downloadable microdata under request-based access.",
"limitations": [
"Surveys are cross-sectional and run infrequently, so a country may have only one usable year.",
"Sampling is designed for national estimates; sub-national power is uneven and often insufficient.",
"Field BP measurement protocol (single visit, device) differs from clinical diagnosis, so control status is approximate.",
"Source date is approximate — the collection is continuously updated rather than published once."
],
"confidence": "high"
},
{
"id": "dhs-program-biomarkers",
"problem_id": "public-health/hypertension-control-global",
"claim": "The DHS Program measures blood pressure as a biomarker for women and men aged 15 and over in selected surveys, providing an additional source of measured-BP prevalence with georeferenced clusters in some LMICs.",
"evidence_type": "dataset",
"source": {
"title": "The DHS Program — Biomarkers",
"url": "https://www.dhsprogram.com/What-We-Do/Biomarkers.cfm"
},
"source_date": "2024-01-01",
"access_date": "2026-06-18",
"method": "Reviewed the DHS biomarkers page and confirmed blood pressure is among collected biomarkers for ages 15+; cross-checked that BP is a recent and survey-specific addition, not universal across all DHS rounds.",
"limitations": [
"Blood pressure is collected only in a subset of DHS surveys and countries, not all rounds.",
"Treatment and control cascade items are not consistently captured, so DHS is stronger for prevalence than for control.",
"Source date is approximate — this is a continuously maintained program page, not a dated publication."
],
"confidence": "medium"
},
{
"id": "gbd-2021-high-sbp-burden",
"problem_id": "public-health/hypertension-control-global",
"claim": "GBD 2021 (IHME) provides modeled estimates of deaths and DALYs attributable to high systolic blood pressure by country, sex, age, and selected subnational units for 1990-2021, usable as a burden-context layer but not as a direct detection-treatment-control measurement.",
"evidence_type": "dataset",
"source": {
"title": "Global Burden of Disease Study 2021 (GBD 2021) Burden and Strength of Evidence by Risk Factor 1990-2021",
"url": "https://ghdx.healthdata.org/record/ihme-data/gbd-2021-burden-by-risk-1990-2021"
},
"source_date": "2024-05-18",
"access_date": "2026-06-18",
"method": "Opened the GHDx record for the GBD 2021 risk-factor burden product and confirmed it covers high systolic blood pressure attributable burden with subnational coverage for a subset of countries.",
"limitations": [
"Outputs are attributable burden (deaths, DALYs), not measured detection, treatment, or control rates.",
"Values are modeled estimates with uncertainty intervals, not survey observations.",
"Subnational estimates exist only for a subset of countries."
],
"confidence": "medium"
},
{
"id": "pure-study-hypertension-2013",
"problem_id": "public-health/hypertension-control-global",
"claim": "The PURE study reported hypertension prevalence, awareness, treatment, and control across high-, middle-, and low-income countries using measured blood pressure in 142042 adults aged 35-70 from 628 communities, documenting markedly lower control in lower-income settings.",
"evidence_type": "peer-reviewed-study",
"source": {
"title": "Prevalence, Awareness, Treatment, and Control of Hypertension in Rural and Urban Communities in High-, Middle-, and Low-Income Countries (PURE)",
"url": "https://pubmed.ncbi.nlm.nih.gov/24002282/"
},
"source_date": "2013-09-04",
"access_date": "2026-06-18",
"method": "Read the PubMed record and abstract to confirm cohort size, age range, country mix, and that the cascade was based on measured blood pressure.",
"limitations": [
"Sample is community cohorts, not nationally representative, so country estimates are not generalizable.",
"Age range is restricted to 35-70 years.",
"Data were collected 2003-2009, so figures are dated relative to current control programs."
],
"confidence": "medium"
},
{
"id": "self-report-hypertension-bias-2022",
"problem_id": "public-health/hypertension-control-global",
"claim": "Self-reported hypertension diagnosis underestimates measured prevalence by roughly 20 percent in women and 55 percent in men in a large Indian survey, which is the documented basis for rejecting self-report-only household surveys as a prevalence source for this pack.",
"evidence_type": "peer-reviewed-study",
"source": {
"title": "Inconsistency in prevalence of hypertension based on self-reports and use of standard tests: Implications for large scale surveys",
"url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC9547289/"
},
"source_date": "2022-10-03",
"access_date": "2026-06-18",
"method": "Read the open-access article and its results to confirm the direction and magnitude of self-report bias against standard measured tests, then applied it as the rejection rule for self-report-only sources.",
"limitations": [
"Quantified bias is from India and may differ in magnitude elsewhere.",
"The study justifies rejecting self-report for prevalence; it is not itself a usable cross-country data source.",
"It does not address treatment or control measurement specifically."
],
"confidence": "high"
}
]
24 changes: 24 additions & 0 deletions problem-packs/public-health/hypertension-control-global/evidence.md
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WHO estimates 1.3 billion adults have hypertension, with only 45 percent diagnosed and 20 percent controlled globally, and control rates below 10 percent in most LMICs.

### ncd-risc-hypertension-trends-2021

NCD-RisC pooled 1201 measured-BP studies across 184 countries to estimate the detection-treatment-control cascade for ages 30-79 by country and sex, 1990-2019. Usable as the cross-country backbone; national grain only and modeled where data are sparse.

### who-steps-microdata

The WHO NCD Microdata Repository distributes STEPS survey microdata with directly measured blood pressure. Usable for country cascade estimates; sub-national power is uneven and surveys are infrequent.

### dhs-program-biomarkers

The DHS Program measures blood pressure for ages 15+ in selected surveys, with georeferenced clusters. Limited: BP coverage is survey-specific and treatment/control items are inconsistent.

### gbd-2021-high-sbp-burden

GBD 2021 (IHME) supplies modeled deaths and DALYs attributable to high systolic blood pressure, with some subnational coverage. Limited: it is attributable burden, not a measured detection-treatment-control cascade.

### pure-study-hypertension-2013

PURE reported the measured-BP cascade across income groups in 142042 adults aged 35-70 from 628 communities. Limited: non-representative community cohorts, restricted ages, data from 2003-2009.

### self-report-hypertension-bias-2022

A large Indian comparison found self-report underestimates measured hypertension by ~20% (women) to ~55% (men). Basis for rejecting self-report-only household surveys as a prevalence source.

## Evidence Quality Rule

Evidence accepted only when source, method, limitations, and confidence are explicit enough for a reviewer to attack.
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