System Drivers of Hypertension Control in Africa: A Beta Regression and Dynamic Factor Modeling Approach

Abstract

Noncommunicable Disease (NCD) Risk Factor Collaboration supplied population-representative data detailing hypertension management in Africa for individuals aged 30 to 79 years from 1990-2019. Ten cascade indicators were analysed via both age-standardized and crude metrics. Beta regression with a logit link and a continuous function of year was used to assess the effects of sex on each outcome. A one-factor state‒space model integrated mixed temporal dynamics and enabled forecasts extending to 2030, adding policy scenario that enhances diagnosis and treatment by 10 percentage points. Compared with men, women were more likely to receive therapy and control on both metrics (odds ratios of approximately 2.2 and 2.1). Diagnosis indicated negligible benefits for females. Women presented a greater prevalence of untreated stage-2 disease, although they demonstrated superior control. A prevalent latent factor indicated significant persistence (ϕ approximately 0.98). By 2030, the scenario indicated a significant increase in control, particularly for women. Findings also indicate the need for increased capacity to prevent the onset of severe uncontrolled disease. The results reveal a dual approach of treatment and management while simultaneously emphasizing diagnosis and intervention. It is recommended to implement a cohesive data pipeline featuring monthly joint-factor dashboards and prompt remedial measures linked to control and untreated stage-2 indications.