Prevalence and associated factors of forgone care among hypertensive patients in selected public hospitals in Addis Ababa, Ethiopia: Cross-sectional study

Prevalence and associated factors of forgone care among hypertensive patients in selected public hospitals in Addis Ababa, Ethiopia: Cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence and associated factors of forgone care among hypertensive patients in selected public hospitals in Addis Ababa, Ethiopia: Cross-sectional study Kirubel Workiye Gebretsadik, Biruktawit Destaw Enkoye, Feruza Mehammed Suleyiman This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3954324/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Hypertension is a complex chronic disease requiring appropriate continuous medical care, and forgone care may exacerbate the severity of the disease and associated complications. The assessment of forgone care indicates the gap between perceived need and actual utilization of healthcare services. This study aimed to investigate the prevalence and associated factors affecting forgone care in patients with hypertension. Method A cross-sectional study was also conducted. Study subjects were selected by using a systematic sampling technique. The data were collected using an interview-administered written questionnaire. A descriptive analysis was conducted to obtain a summary value for each variable. All variables with a p value < 0.25 in the bivariate analysis were entered into a multivariable logistic regression model to identify factors that were significantly associated with the outcome variable. A p value < 0.05 indicated statistical significance. The data are presented in statements, tables, and graphs. Results A total of 405 patients were included in the study. Of these, 35.2% reported forgone care. The most frequently stated reason for forgoing care was the financial burden resulting from the costs of disease treatment (46.3%). According to the final multivariable regression model, the odds of receiving care among hypertensive patients who did not have community-based health insurance were 2.754 times greater than those among those who did. The odds of receiving care among hypertensive patients who did not have family support were 2.31 times greater than those among patients who had family support. Conclusion and recommendation: A considerable number of patients with hypertension had a history of forgoing care, and the most important reasons for forgoing care were related to financial pressure and lack of family support for receiving treatment. A qualitative study is needed to further investigate the underlying reasons why hypertensive patients forgo healthcare. Health Policy Hypertension Forgone care Treatment withdrawal Relinquished care Figures Figure 1 Introduction Forgone treatment was defined as the frequency with which a person self-reported skipping out of medical care while they were ill and in need of it in the year before the survey day( 1 ). A person who forgone medical care does not use medical services even when they believe they are necessary( 2 ). Forgoing care is a significant factor in evaluating the effectiveness of the healthcare system because it highlights a discrepancy between the public's perception of their need for care and their actual utilization. A lack of care can have a variety of negative effects, such as the advancement of an illness, increased usage of emergency rooms, "worrying," and/or difficulties going about daily tasks( 2 , 3 ). People who reported forgoing care can be categorized into two groups: group (I), people who believe they need healthcare and that a professional would confirm that need (both subjective and objective need); and group (II), people who believe they need healthcare but that a professional would not confirm that need (subjective but not objective need). Both types of forgone care are highly relevant for the individuals, health care providers, and, eventually, the health care system. Reported forgone care points to impediments to healthcare utilization( 2 ). According to a recent World Health Organization (WHO) report, the cost of healthcare has thrown approximately 100 million people worldwide into "severe poverty." Many people around the world must make difficult decisions to forgo necessary medical care due to cost, which is especially difficult for those who live in low- to middle-income nations where the proportion of out-of-pocket spending can be significant( 4 ). Research on forgone care among patients with CVD has been carried out mainly in Europe, the USA, and Canada. Research from Africa is largely unavailable. Previous research has associated delayed and forgone medical care with lower health outcomes and more expensive medical care, particularly in the older population( 5 ). Despite being one of the most modifiable risk factors for cardiovascular illnesses, the prevention and treatment of hypertension have not received the attention of many poor nations( 6 ). Because HIV/AIDS, tuberculosis, and malaria are given top priority in these nations, there is a severe lack of awareness, treatment, and control of hypertension( 7 ). According to the 2019 WHO Africa report, in Ethiopia, where CVD was by far the most common NCD-related cause of death, hypertension was one of the main risk factors. In this report, 15.9% of people in the population had hypertension; however, just 1.5% of them had hypertension under control, and 2.8% received necessary care( 8 ). Therefore, it is very important to understand the prevalence of forgone care and associated factors for public health programs and intervention designs among hypertensive patients in the Ethiopian context. The government of Ethiopia is concentrating its efforts on establishing universal health care. To achieve universal health coverage, it is essential to try to recognize and remove obstacles that prevent people from receiving the medical care they require. Less attention has been given to comprehending issues related to forgoing health needs. Forgone care is an important component of unmet health needs; it delays and lowers quality care and involves an individual not using health care despite the need for it. Therefore, this study aimed to assess the prevalence and associated factors of forgone care in hypertensive patients in Addis Ababa, Ethiopia. This research will identify the most common reasons for forgone care. Methods Study area and period: The study was conducted from May 22 to June 22, 2023, at selected public hospitals (namely, Yekatit 12 Hospital Medical College, Ras Desta Damtew Memorial Hospital, and Menelik II Comprehensive Specialized Hospital) in Addis Ababa, Ethiopia. Study Design: A cross-sectional study was conducted on hypertensive patients in selected public hospitals in 2023. Source and Study Population: The source population was all hypertensive patients in selected public hospitals in Addis Ababa during the study period. The study population included hypertensive patients who met the eligibility criteria at selected public hospitals in Addis Ababa during the study period. Study unit: patients Inclusion criteria: All hypertensive patients aged > 18 years were admitted to the hospital outpatient department and emergency department. Exclusion criteria: Seriously ill hypertensive patients and hypertensive patients with a major psychiatric problem, which was recorded on the patient chart, were excluded from the study. Sampling Procedure First, a list of public hospitals in Addis Ababa was identified, and three public hospitals were included randomly in the study (1 teaching hospital, 1 specialized hospital, and 1 general hospital). Second, study participants who were diagnosed with hypertension were identified by using inclusion and exclusion criteria. Based on the total number of hypertensive patients available in each hospital during the study period, the sample size of the study was allocated to those hospitals proportional to the number of hypertensive patients. Using the sampling frame, systematic random sampling was used to select and enroll study participants. From the sampling frame, the first sample was selected randomly, and then, every 3rd patient from a selected sample that fulfilled the inclusion criteria was recruited until the sample size was fulfilled for each hospital. Data collection methods Data collection instruments and procedure A structured questionnaire was used to examine the factors affecting foregone care. The data were collected using structured and pretested questionnaires developed based on the relevant literature and modified to match the aims of this study. The appropriateness and applicability of the measures and tools were evaluated by pretest and face validity. The English version of the questionnaire was prepared and translated to Amharic and then back-translated to English to confirm the appropriateness of the translation. All the questionnaires were subsequently subjected to a face-to-face interview to validate the accuracy of the responses. The questionnaire consists of three parts: sociodemographic and social network variables (gender, age, marital status, income status, education status, employment status, household side, village proximity to the hospital), disease-related variables (chronicity in years of hypertension, presence of comorbidity or complications, history of hospitalization due to complications of hypertension during the last year and awareness about hypertension) and items related to reasons for forgoing care (cost, waiting time, community health insurance). Data quality control: Pretesting was performed on 20 randomly selected patients who fulfilled the inclusion criteria during the specified study period before full-scale data collection. Based on the pretest results, the questionnaire was additionally adjusted and administered to the whole sample. All the data collectors and supervisors were trained by the principal researcher. To improve the data quality, double data entry and data cleaning were performed by checking for inconsistent numerical errors and missing parameters. Once the data were completely clean, the data were exported to SPSS version 25.0 software for analysis. Operational definition: Forgone care: Forgone health care is defined as not using health care despite perceiving a need for it( 9 ). Hypertension: Hypertension (high blood pressure) occurs when the pressure in a patient’s blood vessels is too high (140/90 mmHg or higher). It is common but can be severe if not treated. ( 10 ) Monthly income: A person working in Ethiopia typically earns approximately 8,930 ETB. Salaries range from 2,250 ETB (lowest average) to 39,700 ETB (highest average, actual maximum salary is higher)( 11 ). Data processing and analysis: Descriptive statistics were used to calculate the frequency distribution and proportions for categorical variables. Numerical variables were summarized using the mean (± standard deviation) or median (interquartile range) after testing the normality of the variables using the Kolmogorov‒Smirnov test, where a p value > 0.05 indicated a normal distribution. A bivariate logistic regression model was used to assess the factors associated with forgone care among hypertensive patients. Variables with a p value < 0.25 were entered into the multivariable model. A p value of < 0.05 was considered the cutoff point for statistical significance. The degree of association between the dependent and independent variables was assessed using odds ratios (ORs) with 95% CIs. The Hosmer–Lemeshow test was used to compare and rule out the goodness of fit of the models. The dependent variable “forgone care” was dichotomized into 0 = “no forgone care” and 1 = “reported forgone care”. Multicollinearity was also examined, and all covariates with a variance inflation factor < 10 were tolerated. The results are presented in the form of tables, graphs, and text. Results Sociodemographic characteristics From the 423 samples, information was collected from 405 hypertensive patients, for a response rate of 95.7%. The average age of the patients was 57 (SD ± 12) years. Most of the hypertensive patients were married (250 [61.2%]) or female (227 [55.8%]). More than a quarter of the patients did not attend formal school (112 [27.2%]) and were in less than 5 km proximity to the hospitals (165 [39.5%]) and workers (229 [56.3%]). Most of the hypertensive patients had a 4–6 family size (207 [49.6%]), as shown in Table 1 . Table 1 Sociodemographic and health system characteristics of the study population seen at selected public hospitals in Addis Ababa, 2023. (n = 405) Variable category frequency Percent Sociodemography factors sex male 178 44.2 female 227 55.8 Age category =70 54 15.4 Marital status single 34 9.5 married 253 61.2 widowed 79 20.1 divorced 39 9.2 education No formal education 111 27.2 primary 98 24.1 secondary 77 19.1 vocational 60 14.9 College/university 59 14.7 Habitant distance in KM =10 96 24.1 Family size 1–3 153 37.6 4–6 204 49.6 >=7 48 12.8 employment Not worker 176 43.7 worker 229 56.3 CBHI Yes 235 57.7 No 170 42.3 Support from family Yes 276 67.4 No 129 32.6 Disease-related profile The majority of the patients were diagnosed with hypertension within 5 years (210 [50.6%]), followed by 5–9 years (119 [29.1%]). The majority of these patients used hypertensive medications (389 [93.6%]) or more than 1 medication (193 [47.3%]). Approximately half of the patients had a comorbidity (186 [45.4%]), 81 [19.1%] had reported hypertensive complications, and 51 [12.8%] were hospitalized during the last year due to hypertension complications. As shown in Table 2 . Table 2 Common reasons for, symptoms of, and treatment options for hypertensive patients who forgone care at selected public hospitals in Addis Ababa, 2023. (n=405) Variable category Frequency Percentage Common reasons to forgone care Long Waiting time and long process of treatment 45 32.2% The financial burden due to the cost of treatment 65 46.3% Long distances from the health care centers 26 18.8% Inappropriate behavior of health care providers (discriminatory behavior, and disrespectful behavior) 2 1.3% Major symptom or reason encountered while forgone care Follow-up 62 43% Headache 47 32.9% Chest pain 5 4.7% Other (myalgia, leg swelling, numbness…) 26 19.5% The alternative solution used for forgone care Missed follow-up 63 43.6% Herbal medication 15 11.4% Buy anti-pain from pharmacy 46 32.2% Other (does nothing, sleep…) 17 12.8% Factors associated with forgone care The results of the binary logistic regression model are shown in Table 3 . Univariate binary logistic regression was run at a 25% level of significance to select variables to be included in the final multivariable binary logistic regression model, and the following variables were found to be significant: age category, sex, family size, living area category, employment status, income, number of medications, method used for hypertension control, community-based health insurance and family support. The final multivariable binary logistic regression model showed that community-based health insurance, habitant distance, income, and family support were significantly associated with forgone care among hypertensive patients at the 5% level of significance. Accordingly, after adjusting for other covariates included in the final regression model, the odds of forgone care among hypertensive patients who did not have community-based health insurance were 2.754 times greater than those among patients who had community-based health insurance (AOR = 2.754, 95% CI = 1.610, 4.710; p value = 0.000). The odds of receiving care for hypertensive patients who did not have family support were 2.31 times greater than those who had family support (AOR = 2.310, 95% CI = 1.237, 4.315; p value = 0.009). In addition, the odds of reporting forgone care were 61.8% lower for patients who lived within a five-kilometer distance from the hospital and 47.2% lower for patients who lived within five to nine kilometer distances. AOR = 0.382, 95% CI = 0.209, 0.699, p value = 0.002; and AOR = 0.528, 95% CI = 0.294, 1.266, p value = 0.033. The odds of reporting forgone care were 74.4% lower for patients whose monthly income was less than 2250 birr (AOR = 0.256, 95% CI = 0.067, 0.097, p value = 0.046). Table 3 Factors associated with forgone care among hypertensive patients in Addis Ababa, 2023. (n = 405) variable Forgone care COR at 95% CI AOR at 95%CI P value Yes No Community-based health insurance Yes 54(40.3%) 180(67.2%) 1 1 No 85(59.7%) 86(32.8%) 3.033 (2.006, 4.584) 2.754 (1.610, 4.710) 0.000 * Age category < 50 53(36.9%) 68(25.5%) 1.646 (0.878, 3.086) 1.742 (0.613, 4.954) 0.298 50–59 37(26.2%) 83(29.9%) 0.997 (0.523, 1.899) 1.601 (0.581, 4.409) 0.363 60–69 31(22.8) 75(28.5%) 0.913 (0.473, 1.763) 0.951 (0.442, 2.045) 0.897 > 70 18(14.1%) 40(16.1%) 1 1 Family size 1–3 64(45%) 89(33.6%) 0.93 (0.215, 4.113) 0.881 (0.178, 4.368) 0.877 4–6 65(45.6%) 139(51.8%) 2.052 (0.963, 4.373) 1.039 (0.424, 2.544) 0.933 > 6 11(9.4%) 37(14.6%) 1.350 (0.640, 2.846) 0.940 (0.400, 2.209) 0.888 Income category in birr 8900 5(5.4%) 6(2.6%) 1 1 Sex Male 74(52.3%) 104(39.8%) 0.601 (0.402, 0.899) 0.726 (0.440, 1.199) 0.211 Female 67(47.7%) 160(60.2%) 1 1 Support from family Yes 34(25.5%) 242(90.1%) 1 1 No 106(74.5%) 23(9.9%) 3.132 (1.822, 5.384) 2.310 (1.237, 4.315) 0.009 * Number of HTN medication 0 4(2.7%) 21(7.7%) 1 1 1 60(43.6%) 130(48.5%) 0.286 (0.095, 0.864) 0.237 (0.010, 5.731) 0.375 >=2 75(53.7%) 115(43.8%) 0.733 (0.487, 1.105) 0.699 (0.422, 1.157) 0.164 Method do you use for hypertension control Lifestyle only 5(3.4%) 22(8%) 0.398 (0.147, 1.073) 1.103 (0.058, 21.010) 0.948 medication 135(96.6%) 243(92%) 1 1 Employment status reorganized Not worker 54(38.9%) 122(46.4%) 0.738 (0.492, 1.107) 1.896 (0.865, 4.158) 0.110 Worker 87(61.1%) 139(53.6%) 1 1 Note : COR, crude odds ratio; AOR, adjusted odds ratio; CI, confidence interval; * statistically significant Discussion This study aimed to assess the prevalence of forgone care and identify the factors affecting forgone care among patients with hypertension. According to our results, 35.2% of the patients reported forgone care. This result is comparable with those of other studies performed in Kenya, Ghana, and Indonesia( 12 – 14 ). However, this number is greater than that reported in other studies performed in China, Europe, and the USA( 2 , 5 , 15 , 16 ). Given that hypertension and other chronic diseases require long-term care and that the consequences of their treatment are not immediate or short-term, in many cases, the patient cannot make a reasonable association between forgoing treatment and its outcomes. Given the implementation of the Ethiopian Noncommunicable Disease Prevention and Control Program, it can be concluded that the percentage of patients with hypertension receiving forgone care is high, which is indicative of the poor performance of the healthcare system in treating CVD. In this study, the odds of receiving care among hypertensive patients who did not have community-based health insurance were 2.754 times greater than those among patients who had community-based health insurance. These results are in line with those of other studies performed in Kenya, Ghana, Germany, China, and the USA( 2 , 17 – 20 ). Since most patients were elderly individuals with low socioeconomic status and only a small percentage of patients were covered by supplementary insurance, the disease treatment cost was reported as the leading cause of forgone care. For people who were not covered by health insurance, financial barriers to access had a greater impact on their treatment withdrawal. Hypertension imposes a considerable cost on patients, especially lower-income patients. Therefore, to reduce the rate of withdrawal from treatment, it is necessary to provide financial support, such as strengthening community-based health insurance coverage for low-income people to improve their financial access to healthcare services. In the study of L.A. Adebusoye et al. among hypertensive patients, the proportion of hypertensive patients with strong perceived family support was 93.3%, which is in line with our study ( 21 ). In our study, forgone care was more likely to be provided to patients with no family support or no community-based health insurance during the last year. Limitations Some limitations of the study must be acknowledged. The study evaluated foregone care only among hypertensive patients who perceived a need for healthcare but did not seek treatment; however, it did not take into account those with other cardiovascular diseases. The study was performed in selected public hospitals in Addis Ababa; it did not include private hospitals or health centers. Therefore, the prevalence of foregone care may have been underestimated to some extent. In addition, cross-sectional data cannot be used to draw causal conclusions about why these individuals may have foregone care. Conclusion The results showed that despite the implementation of the prevention and control program for noncommunicable diseases, a considerable number of patients with hypertension had a history of forgoing care in selected public hospitals in Addis Ababa, and the most important reasons for forgoing care were related to financial barriers and long waiting times. The findings indicate that individuals without adequate health insurance coverage are more likely to experience barriers to accessing healthcare, leading to a greater likelihood of forgone care. Additionally, longer waiting times to receive treatment contribute to the decision to forgo care, as patients may opt to delay or avoid treatment due to time constraints or worsening symptoms. Finally, the presence of family support serves as a protective factor, as individuals with strong support are more likely to seek timely care. Acronym AARHB……………………… Addis Ababa Regional Health Bureau BP …………………………….blood pressure CVD ………………………….cardio vascular disease EMOH ………………………..Ethiopian Ministry of Health MCH………………………….Maternal and Child Health NCD …………………………..Non-Communicable Disease SDG …………………………..Sustainable Development Goal WHO ………………………….World Health Organization Declarations Ethical considerations : Ethical clearance was obtained from the Addis Ababa Public Health Research and Emergency Management Directorate. Permission letters were obtained from the Addis Ababa City Administration Health Bureau Institutional Review Board. All the study participants were reassured/informed that they would be anonymous. Access to the collected information was limited to the investigators, and confidentiality was maintained throughout the project. Availability of data and materials: All relevant data are available upon reasonable request. Competing interests: The authors declare that they have no known competing interests. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author Contribution : K.W. contributed to the study conception, designed the study, performed the statistical analysis, and drafted the manuscript. B.D. and F.M. assisted in the statistical analysis and drafting of the manuscript. All the authors revised and approved the final manuscript. K.W. contributed to the conception and proposal and writing of the research. Acknowledgments : The authors would like to thank all individuals involved in the facilitation of this research. References Jalilian H, Heydari S, Mir N, Fehresti S, Khodayari-Zarnaq R. Forgone care in patients with type 2 diabetes: a cross-sectional study. BMC Public Health. 2021 Aug 24;21(1):1588. Röttger J, Blümel M, Köppen J, Busse R. Forgone care among chronically ill patients in Germany—Results from a cross-sectional survey with 15,565 individuals. Health Policy [Internet]. 2016 Feb [cited 2022 Dec 22];120(2):170–8. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0168851016000051 Anderson KE, McGinty EE, Presskreischer R, Barry CL. Reports of Forgone Medical Care Among US Adults During the Initial Phase of the COVID-19 Pandemic. JAMA Netw Open [Internet]. 2021 Jan 21 [cited 2023 Feb 6];4(1):e2034882. Available from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2775366 Global Health Expenditure Database [Internet]. [cited 2023 Feb 6]. Available from: https://apps.who.int/nha/database/ Li X, Chen M, Wang Z, Si L. Forgone care among middle aged and elderly with chronic diseases in China: evidence from the China Health and Retirement Longitudinal Study Baseline Survey. BMJ Open [Internet]. 2018 Mar [cited 2023 Feb 6];8(3):e019901. Available from: https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2017-019901 WHO. Noncommunicable diseases (NCD) country profiles. Risk of premature death due to NCDS in Ethiopia. [Internet]. 2018. Available from: https://scholar.google.com/scholar_lookup Geldsetzer P, Manne-Goehler J, Marcus ME, Ebert C, Zhumadilov Z, Wesseh CS, et al. The state of hypertension care in 44 low-income and middle-income countries: a cross-sectional study of nationally representative individual-level data from 1·1 million adults. The Lancet [Internet]. 2019 Aug 24 [cited 2022 Dec 25];394(10199):652–62. Available from: https://www.sciencedirect.com/science/article/pii/S0140673619309559 Guwatudde D, Nankya-Mutyoba J, Kalyesubula R, Laurence C, Adebamowo C, Ajayi I, et al. The burden of hypertension in sub-Saharan Africa: a four-country cross sectional study. BMC Public Health. 2015 Dec 5;15:1211. Tsuzaki K, Taira D. Forgone Health Care for Non–COVID-19–Related Needs Among Medicare Beneficiaries During the COVID-19 Pandemic, Summer 2020–Winter 2021. Prev Chronic Dis [Internet]. 2022 Oct 13 [cited 2023 Feb 6];19:220110. Available from: http://www.cdc.gov/pcd/issues/2022/22_0110.htm WHO. https://www.who.int/news-room/fact-sheets/detail/hypertension. 2021 Aug 25; Average Salary in Ethiopia 2023 - The Complete Guide [Internet]. [cited 2023 Nov 12]. Available from: https://www.salaryexplorer.com/average-salary-wage-comparison-ethiopia-c69?expand_article=1 Ainy A, Idris H, Maharani A. Unmet Need for Healthcare Among People with Hypertension in Indonesia. 2020. Kuria N, Reid A, Owiti P, Tweya H, Kibet CK, Mbau L, et al. Compliance with follow-up and adherence to medication in hypertensive patients in an urban informal settlement in Kenya: comparison of three models of care. Trop Med Int Health TM IH. 2018 Jul;23(7):785–94. Adler AJ, Laar A, Prieto-Merino D, Der RMM, Mangortey D, Dirks R, et al. Can a nurse-led community-based model of hypertension care improve hypertension control in Ghana? Results from the ComHIP cohort study. BMJ Open. 2019 Apr 1;9(4):e026799. Lucevic A, Péntek M, Kringos D, Klazinga N, Gulácsi L, Brito Fernandes Ó, et al. Unmet medical needs in ambulatory care in Hungary: forgone visits and medications from a representative population survey. Eur J Health Econ [Internet]. 2019 Jun [cited 2023 Jan 19];20(S1):71–8. Available from: http://link.springer.com/10.1007/s10198-019-01063-0 Thomas A, Valero-Elizondo J, Khera R, Warraich HJ, Reinhardt SW, Ali HJ, et al. Forgone Medical Care Associated With Increased Health Care Costs Among the U.S. Heart Failure Population. JACC Heart Fail. 2021 Oct;9(10):710–9. Bonfrer I, Gustafsson-Wright E. Health shocks, coping strategies and foregone healthcare among agricultural households in Kenya. Glob Public Health. 2017 Nov 2;12(11):1369–90. Bodenmann P, Favrat B, Wolff H, Guessous I, Panese F, Herzig L, et al. Screening Primary-Care Patients Forgoing Health Care for Economic Reasons. PLoS ONE. 2014 Apr 3;9(4):e94006. Werner P, Tur-Sinai A. Prevalence and correlates of forgone care among adult Israeli Jews: A survey conducted during the COVID-19 outbreak. PloS One. 2021;16(11):e0260399. Forgone Health and Economic Benefits Associated with Socioeconomic Differences in Organized Cervical Cancer Screening - PMC [Internet]. 2023 [cited 2023 Feb 6]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7173370/ Ilori HT, Adebusoye LA, Daramola OO, Ajetunmobi OA. Perceived family support and its effect on cardiovascular disease risk among hypertensive patients presenting at a family medicine practice in south west nigeria. Niger J Fam Pract. 2020;11(2):19–26. Additional Declarations The authors declare no competing interests. Supplementary Files supplementary.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3954324","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":272708412,"identity":"04b1b8d5-9371-444d-b01d-56528f076bcd","order_by":0,"name":"Kirubel Workiye Gebretsadik","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABA0lEQVRIiWNgGAWjYBACCWYGBiCyADLZGA4wMNgAGYyNB4jQIgHTkgbS0oBfCwOSFiA4DBbFq0WynfeZdEGFRGK/9LHEwzwV5+3Wth8G2lJjE41LizQzu5n0jDMSiTP70g4c5jlzO3nbmUSglmNpuQ04tMgxs7FJ87ZJ5G44w95wmLftdrLZAaAWxobDBLT8g2n5dy7Z7PxD/FqkwVoaQFrYDhzmbThgZ3aDgC2SzWzM1jOOSdTP7GFLODjnWHKC2Q2gLQl4/CJx/hjj7YIaG2N+HjbjD29q7OzNzqc/fPChxganFhTAxMPAkAhWmUCMchBg/MHAYE+s4lEwCkbBKBg5AAAS1l0oaWSXZgAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0003-0093-6522","institution":"Ras Desta Damtew Memorial Hospital","correspondingAuthor":true,"prefix":"","firstName":"Kirubel","middleName":"Workiye","lastName":"Gebretsadik","suffix":""},{"id":272708413,"identity":"a52132de-8e23-41a3-b5ae-b399b7cf28f4","order_by":1,"name":"Biruktawit Destaw Enkoye","email":"","orcid":"","institution":"Redat Healthcare","correspondingAuthor":false,"prefix":"","firstName":"Biruktawit","middleName":"Destaw","lastName":"Enkoye","suffix":""},{"id":272708414,"identity":"7d500332-4a8e-4232-af98-105528190633","order_by":2,"name":"Feruza Mehammed Suleyiman","email":"","orcid":"","institution":"Gandi Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Feruza","middleName":"Mehammed","lastName":"Suleyiman","suffix":""}],"badges":[],"createdAt":"2024-02-13 19:56:49","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-3954324/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3954324/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":51137710,"identity":"f0791a37-5594-45bf-8f21-078ea96f011e","added_by":"auto","created_at":"2024-02-14 18:47:42","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":26637,"visible":true,"origin":"","legend":"\u003cp\u003edemonstrate the prevalence of forgone care among hypertensive patients in selected public hospitals in Addis Ababa within the last 12 months.\u003c/p\u003e","description":"","filename":"forg.png","url":"https://assets-eu.researchsquare.com/files/rs-3954324/v1/ddc2b61244fb265d62d3fc84.png"},{"id":51138055,"identity":"b06d1946-4bd9-49dc-ad40-4d42f675e008","added_by":"auto","created_at":"2024-02-14 18:55:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":401800,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3954324/v1/fdab0e7e-d3ca-476e-b139-bd59c1ae64aa.pdf"},{"id":51137711,"identity":"be92d6b3-4eb5-44f6-aa3f-28b468e1c1f4","added_by":"auto","created_at":"2024-02-14 18:47:42","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":23023,"visible":true,"origin":"","legend":"","description":"","filename":"supplementary.docx","url":"https://assets-eu.researchsquare.com/files/rs-3954324/v1/ecbc3b86ce1f06ff8ecda59a.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003ePrevalence and associated factors of forgone care among hypertensive patients in selected public hospitals in Addis Ababa, Ethiopia: Cross-sectional study\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eForgone treatment was defined as the frequency with which a person self-reported skipping out of medical care while they were ill and in need of it in the year before the survey day(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). A person who forgone medical care does not use medical services even when they believe they are necessary(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Forgoing care is a significant factor in evaluating the effectiveness of the healthcare system because it highlights a discrepancy between the public's perception of their need for care and their actual utilization. A lack of care can have a variety of negative effects, such as the advancement of an illness, increased usage of emergency rooms, \"worrying,\" and/or difficulties going about daily tasks(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). People who reported forgoing care can be categorized into two groups: group (I), people who believe they need healthcare and that a professional would confirm that need (both subjective and objective need); and group (II), people who believe they need healthcare but that a professional would not confirm that need (subjective but not objective need). Both types of forgone care are highly relevant for the individuals, health care providers, and, eventually, the health care system. Reported forgone care points to impediments to healthcare utilization(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). According to a recent World Health Organization (WHO) report, the cost of healthcare has thrown approximately 100\u0026nbsp;million people worldwide into \"severe poverty.\" Many people around the world must make difficult decisions to forgo necessary medical care due to cost, which is especially difficult for those who live in low- to middle-income nations where the proportion of out-of-pocket spending can be significant(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eResearch on forgone care among patients with CVD has been carried out mainly in Europe, the USA, and Canada. Research from Africa is largely unavailable. Previous research has associated delayed and forgone medical care with lower health outcomes and more expensive medical care, particularly in the older population(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Despite being one of the most modifiable risk factors for cardiovascular illnesses, the prevention and treatment of hypertension have not received the attention of many poor nations(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Because HIV/AIDS, tuberculosis, and malaria are given top priority in these nations, there is a severe lack of awareness, treatment, and control of hypertension(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). According to the 2019 WHO Africa report, in Ethiopia, where CVD was by far the most common NCD-related cause of death, hypertension was one of the main risk factors. In this report, 15.9% of people in the population had hypertension; however, just 1.5% of them had hypertension under control, and 2.8% received necessary care(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Therefore, it is very important to understand the prevalence of forgone care and associated factors for public health programs and intervention designs among hypertensive patients in the Ethiopian context.\u003c/p\u003e \u003cp\u003eThe government of Ethiopia is concentrating its efforts on establishing universal health care. To achieve universal health coverage, it is essential to try to recognize and remove obstacles that prevent people from receiving the medical care they require. Less attention has been given to comprehending issues related to forgoing health needs. Forgone care is an important component of unmet health needs; it delays and lowers quality care and involves an individual not using health care despite the need for it.\u003c/p\u003e \u003cp\u003eTherefore, this study aimed to assess the prevalence and associated factors of forgone care in hypertensive patients in Addis Ababa, Ethiopia. This research will identify the most common reasons for forgone care.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003eStudy area and period:\u003c/h2\u003e\n\u003cp\u003eThe study was conducted from May 22 to June 22, 2023, at selected public hospitals (namely, Yekatit 12 Hospital Medical College, Ras Desta Damtew Memorial Hospital, and Menelik II Comprehensive Specialized Hospital) in Addis Ababa, Ethiopia.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n\u003ch2\u003eStudy Design:\u003c/h2\u003e\n\u003cp\u003eA cross-sectional study was conducted on hypertensive patients in selected public hospitals in 2023.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n\u003ch2\u003eSource and Study Population:\u003c/h2\u003e\n\u003cp\u003eThe source population was all hypertensive patients in selected public hospitals in Addis Ababa during the study period.\u003c/p\u003e\n\u003cp\u003eThe study population included hypertensive patients who met the eligibility criteria at selected public hospitals in Addis Ababa during the study period.\u003c/p\u003e\n\u003cp\u003eStudy unit: patients\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n\u003ch2\u003eInclusion criteria:\u003c/h2\u003e\n\u003cp\u003eAll hypertensive patients aged\u0026thinsp;\u0026gt;\u0026thinsp;18 years were admitted to the hospital outpatient department and emergency department.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n\u003ch2\u003eExclusion criteria:\u003c/h2\u003e\n\u003cp\u003eSeriously ill hypertensive patients and hypertensive patients with a major psychiatric problem, which was recorded on the patient chart, were excluded from the study.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003eSampling Procedure\u003c/h2\u003e\n\u003cp\u003eFirst, a list of public hospitals in Addis Ababa was identified, and three public hospitals were included randomly in the study (1 teaching hospital, 1 specialized hospital, and 1 general hospital). Second, study participants who were diagnosed with hypertension were identified by using inclusion and exclusion criteria. Based on the total number of hypertensive patients available in each hospital during the study period, the sample size of the study was allocated to those hospitals proportional to the number of hypertensive patients. Using the sampling frame, systematic random sampling was used to select and enroll study participants. From the sampling frame, the first sample was selected randomly, and then, every 3rd patient from a selected sample that fulfilled the inclusion criteria was recruited until the sample size was fulfilled for each hospital.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n\u003ch2\u003eData collection methods\u003c/h2\u003e\n\u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\n\u003ch2\u003eData collection instruments and procedure\u003c/h2\u003e\n\u003cp\u003eA structured questionnaire was used to examine the factors affecting foregone care. The data were collected using structured and pretested questionnaires developed based on the relevant literature and modified to match the aims of this study. The appropriateness and applicability of the measures and tools were evaluated by pretest and face validity. The English version of the questionnaire was prepared and translated to Amharic and then back-translated to English to confirm the appropriateness of the translation. All the questionnaires were subsequently subjected to a face-to-face interview to validate the accuracy of the responses. The questionnaire consists of three parts: sociodemographic and social network variables (gender, age, marital status, income status, education status, employment status, household side, village proximity to the hospital), disease-related variables (chronicity in years of hypertension, presence of comorbidity or complications, history of hospitalization due to complications of hypertension during the last year and awareness about hypertension) and items related to reasons for forgoing care (cost, waiting time, community health insurance).\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003eData quality control:\u003c/h2\u003e\n\u003cp\u003ePretesting was performed on 20 randomly selected patients who fulfilled the inclusion criteria during the specified study period before full-scale data collection. Based on the pretest results, the questionnaire was additionally adjusted and administered to the whole sample.\u003c/p\u003e\n\u003cp\u003eAll the data collectors and supervisors were trained by the principal researcher. To improve the data quality, double data entry and data cleaning were performed by checking for inconsistent numerical errors and missing parameters. Once the data were completely clean, the data were exported to SPSS version 25.0 software for analysis.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n\u003ch2\u003eOperational definition:\u003c/h2\u003e\n\u003cp\u003eForgone care: Forgone health care is defined as not using health care despite perceiving a need for it(\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eHypertension: Hypertension (high blood pressure) occurs when the pressure in a patient\u0026rsquo;s blood vessels is too high (140/90 mmHg or higher). It is common but can be severe if not treated. (\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e\n\u003cp\u003eMonthly income: A person working in Ethiopia typically earns approximately 8,930 ETB. Salaries range from 2,250 ETB (lowest average) to 39,700 ETB (highest average, actual maximum salary is higher)(\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n\u003ch2\u003eData processing and analysis:\u003c/h2\u003e\n\u003cp\u003eDescriptive statistics were used to calculate the frequency distribution and proportions for categorical variables. Numerical variables were summarized using the mean (\u0026plusmn;\u0026thinsp;standard deviation) or median (interquartile range) after testing the normality of the variables using the Kolmogorov‒Smirnov test, where a p value\u0026thinsp;\u0026gt;\u0026thinsp;0.05 indicated a normal distribution. A bivariate logistic regression model was used to assess the factors associated with forgone care among hypertensive patients. Variables with a p value\u0026thinsp;\u0026lt;\u0026thinsp;0.25 were entered into the multivariable model. A p value of \u0026lt;\u0026thinsp;0.05 was considered the cutoff point for statistical significance. The degree of association between the dependent and independent variables was assessed using odds ratios (ORs) with 95% CIs. The Hosmer\u0026ndash;Lemeshow test was used to compare and rule out the goodness of fit of the models. The dependent variable \u0026ldquo;forgone care\u0026rdquo; was dichotomized into 0 = \u0026ldquo;no forgone care\u0026rdquo; and 1 = \u0026ldquo;reported forgone care\u0026rdquo;. Multicollinearity was also examined, and all covariates with a variance inflation factor\u0026thinsp;\u0026lt;\u0026thinsp;10 were tolerated. The results are presented in the form of tables, graphs, and text.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n\u003ch2\u003eSociodemographic characteristics\u003c/h2\u003e\n\u003cp\u003eFrom the 423 samples, information was collected from 405 hypertensive patients, for a response rate of 95.7%. The average age of the patients was 57 (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;12) years. Most of the hypertensive patients were married (250 [61.2%]) or female (227 [55.8%]). More than a quarter of the patients did not attend formal school (112 [27.2%]) and were in less than 5 km proximity to the hospitals (165 [39.5%]) and workers (229 [56.3%]). Most of the hypertensive patients had a 4\u0026ndash;6 family size (207 [49.6%]), as shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eSociodemographic and health system characteristics of the study population seen at selected public hospitals in Addis Ababa, 2023. (n\u0026thinsp;=\u0026thinsp;405)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eVariable category\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003efrequency\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePercent\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eSociodemography factors\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003esex\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003emale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e178\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e44.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003efemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e227\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e55.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eAge category\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e120\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e29.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50\u0026ndash;59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e125\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e28.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e60\u0026ndash;69\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e106\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e26.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;=70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e15.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eMarital status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003esingle\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003emarried\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e253\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e61.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ewidowed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003edivorced\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"5\" align=\"left\"\u003e\n\u003cp\u003eeducation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo formal education\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e111\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e27.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eprimary\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e98\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e24.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003esecondary\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e77\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e19.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003evocational\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCollege/university\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eHabitant distance in KM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e161\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e39.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u0026ndash;9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e148\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e36.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;=10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e96\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e24.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFamily size\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u0026ndash;3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e153\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e37.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u0026ndash;6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e204\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e49.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;=7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e12.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eemployment\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNot worker\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e176\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e43.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eworker\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e229\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e56.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eCBHI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e235\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e57.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e170\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e42.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eSupport from family\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e276\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e67.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e129\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e32.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n\u003ch2\u003eDisease-related profile\u003c/h2\u003e\n\u003cp\u003eThe majority of the patients were diagnosed with hypertension within 5 years (210 [50.6%]), followed by 5\u0026ndash;9 years (119 [29.1%]). The majority of these patients used hypertensive medications (389 [93.6%]) or more than 1 medication (193 [47.3%]). Approximately half of the patients had a comorbidity (186 [45.4%]), 81 [19.1%] had reported hypertensive complications, and 51 [12.8%] were hospitalized during the last year due to hypertension complications. As shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Taba\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cp\u003eTable 2\u003c/p\u003e\n\u003cp\u003eCommon reasons for, symptoms of, and treatment options for hypertensive patients who forgone care at selected public hospitals in Addis Ababa, 2023. (n=405)\u003c/p\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable category\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eFrequency\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePercentage\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eCommon reasons to forgone care\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLong Waiting time and long process of treatment\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32.2%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eThe financial burden due to the cost of treatment\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e46.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLong distances from the health care centers\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInappropriate behavior of health care providers (discriminatory behavior, and disrespectful behavior)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eMajor symptom or reason encountered while forgone care\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFollow-up\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e62\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e43%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHeadache\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e47\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChest pain\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOther (myalgia, leg swelling, numbness\u0026hellip;)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eThe alternative solution used for forgone care\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMissed follow-up\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e63\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e43.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHerbal medication\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBuy anti-pain from pharmacy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32.2%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOther (does nothing, sleep\u0026hellip;)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n\u003ch2\u003eFactors associated with forgone care\u003c/h2\u003e\n\u003cp\u003eThe results of the binary logistic regression model are shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e. Univariate binary logistic regression was run at a 25% level of significance to select variables to be included in the final multivariable binary logistic regression model, and the following variables were found to be significant: age category, sex, family size, living area category, employment status, income, number of medications, method used for hypertension control, community-based health insurance and family support.\u003c/p\u003e\n\u003cp\u003eThe final multivariable binary logistic regression model showed that community-based health insurance, habitant distance, income, and family support were significantly associated with forgone care among hypertensive patients at the 5% level of significance.\u003c/p\u003e\n\u003cp\u003eAccordingly, after adjusting for other covariates included in the final regression model, the odds of forgone care among hypertensive patients who did not have community-based health insurance were 2.754 times greater than those among patients who had community-based health insurance (AOR\u0026thinsp;=\u0026thinsp;2.754, 95% CI\u0026thinsp;=\u0026thinsp;1.610, 4.710; p value\u0026thinsp;=\u0026thinsp;0.000). The odds of receiving care for hypertensive patients who did not have family support were 2.31 times greater than those who had family support (AOR\u0026thinsp;=\u0026thinsp;2.310, 95% CI\u0026thinsp;=\u0026thinsp;1.237, 4.315; p value\u0026thinsp;=\u0026thinsp;0.009). In addition, the odds of reporting forgone care were 61.8% lower for patients who lived within a five-kilometer distance from the hospital and 47.2% lower for patients who lived within five to nine kilometer distances. AOR\u0026thinsp;=\u0026thinsp;0.382, 95% CI\u0026thinsp;=\u0026thinsp;0.209, 0.699, p value\u0026thinsp;=\u0026thinsp;0.002; and AOR\u0026thinsp;=\u0026thinsp;0.528, 95% CI\u0026thinsp;=\u0026thinsp;0.294, 1.266, p value\u0026thinsp;=\u0026thinsp;0.033. The odds of reporting forgone care were 74.4% lower for patients whose monthly income was less than 2250 birr (AOR\u0026thinsp;=\u0026thinsp;0.256, 95% CI\u0026thinsp;=\u0026thinsp;0.067, 0.097, p value\u0026thinsp;=\u0026thinsp;0.046).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eFactors associated with forgone care among hypertensive patients in Addis Ababa, 2023. (n\u0026thinsp;=\u0026thinsp;405)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003evariable\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eForgone care\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eCOR at 95% CI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eAOR at 95%CI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eP value\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eCommunity-based health insurance\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54(40.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e180(67.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e85(59.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e86(32.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.033 (2.006, 4.584)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.754 (1.610, 4.710)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.000\u003cstrong\u003e*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eAge category\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e53(36.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e68(25.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.646 (0.878, 3.086)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.742 (0.613, 4.954)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.298\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50\u0026ndash;59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37(26.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e83(29.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.997 (0.523, 1.899)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.601 (0.581, 4.409)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.363\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e60\u0026ndash;69\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31(22.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e75(28.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.913 (0.473, 1.763)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.951 (0.442, 2.045)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.897\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;\u0026thinsp;70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18(14.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40(16.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eFamily size\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u0026ndash;3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e64(45%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e89(33.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.93 (0.215, 4.113)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.881 (0.178, 4.368)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.877\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u0026ndash;6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e65(45.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e139(51.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.052 (0.963, 4.373)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.039 (0.424, 2.544)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.933\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;\u0026thinsp;6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11(9.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37(14.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.350 (0.640, 2.846)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.940 (0.400, 2.209)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.888\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eIncome category in birr\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;2250\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24(18.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e87(32.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.263 (0.087, 0.790)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.256 (0.067, 0.977)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.046\u003cstrong\u003e*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2251\u0026ndash;8900\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e110(76.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e173(64.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.564 (0.199, 1.597)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.491 (0.145, 1.664)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.253\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;\u0026thinsp;8900\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5(5.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6(2.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eSex\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e74(52.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e104(39.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.601 (0.402, 0.899)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.726 (0.440, 1.199)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.211\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e67(47.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e160(60.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eSupport from\u003c/p\u003e\n\u003cp\u003efamily\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34(25.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e242(90.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e106(74.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23(9.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.132 (1.822, 5.384)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.310 (1.237, 4.315)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.009\u003cstrong\u003e*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eNumber of HTN medication\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4(2.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21(7.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e60(43.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e130(48.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.286 (0.095, 0.864)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.237 (0.010, 5.731)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.375\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;=2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e75(53.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e115(43.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.733 (0.487, 1.105)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.699 (0.422, 1.157)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.164\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eMethod do you use for hypertension\u003c/p\u003e\n\u003cp\u003econtrol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLifestyle only\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5(3.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22(8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.398 (0.147, 1.073)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.103 (0.058, 21.010)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.948\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003emedication\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e135(96.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e243(92%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eEmployment\u003c/p\u003e\n\u003cp\u003estatus\u003c/p\u003e\n\u003cp\u003ereorganized\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNot worker\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54(38.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e122(46.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.738 (0.492, 1.107)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.896 (0.865, 4.158)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.110\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWorker\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e87(61.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e139(53.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"7\"\u003e\u003cstrong\u003eNote\u003c/strong\u003e: COR, crude odds ratio; AOR, adjusted odds ratio; CI, confidence interval; \u003cstrong\u003e*\u003c/strong\u003estatistically significant\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to assess the prevalence of forgone care and identify the factors affecting forgone care among patients with hypertension. According to our results, 35.2% of the patients reported forgone care. This result is comparable with those of other studies performed in Kenya, Ghana, and Indonesia(\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). However, this number is greater than that reported in other studies performed in China, Europe, and the USA(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Given that hypertension and other chronic diseases require long-term care and that the consequences of their treatment are not immediate or short-term, in many cases, the patient cannot make a reasonable association between forgoing treatment and its outcomes. Given the implementation of the Ethiopian Noncommunicable Disease Prevention and Control Program, it can be concluded that the percentage of patients with hypertension receiving forgone care is high, which is indicative of the poor performance of the healthcare system in treating CVD.\u003c/p\u003e \u003cp\u003eIn this study, the odds of receiving care among hypertensive patients who did not have community-based health insurance were 2.754 times greater than those among patients who had community-based health insurance. These results are in line with those of other studies performed in Kenya, Ghana, Germany, China, and the USA(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR18 CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Since most patients were elderly individuals with low socioeconomic status and only a small percentage of patients were covered by supplementary insurance, the disease treatment cost was reported as the leading cause of forgone care. For people who were not covered by health insurance, financial barriers to access had a greater impact on their treatment withdrawal. Hypertension imposes a considerable cost on patients, especially lower-income patients. Therefore, to reduce the rate of withdrawal from treatment, it is necessary to provide financial support, such as strengthening community-based health insurance coverage for low-income people to improve their financial access to healthcare services. In the study of L.A. Adebusoye et al. among hypertensive patients, the proportion of hypertensive patients with strong perceived family support was 93.3%, which is in line with our study (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn our study, forgone care was more likely to be provided to patients with no family support or no community-based health insurance during the last year.\u003c/p\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eSome limitations of the study must be acknowledged. The study evaluated foregone care only among hypertensive patients who perceived a need for healthcare but did not seek treatment; however, it did not take into account those with other cardiovascular diseases. The study was performed in selected public hospitals in Addis Ababa; it did not include private hospitals or health centers. Therefore, the prevalence of foregone care may have been underestimated to some extent. In addition, cross-sectional data cannot be used to draw causal conclusions about why these individuals may have foregone care.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe results showed that despite the implementation of the prevention and control program for noncommunicable diseases, a considerable number of patients with hypertension had a history of forgoing care in selected public hospitals in Addis Ababa, and the most important reasons for forgoing care were related to financial barriers and long waiting times. The findings indicate that individuals without adequate health insurance coverage are more likely to experience barriers to accessing healthcare, leading to a greater likelihood of forgone care. Additionally, longer waiting times to receive treatment contribute to the decision to forgo care, as patients may opt to delay or avoid treatment due to time constraints or worsening symptoms. Finally, the presence of family support serves as a protective factor, as individuals with strong support are more likely to seek timely care.\u003c/p\u003e"},{"header":"Acronym","content":"\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eAARHB\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip; Addis Ababa Regional Health Bureau\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eBP \u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.blood pressure\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eCVD \u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.cardio vascular disease\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eEMOH \u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..Ethiopian Ministry of Health\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eMCH\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.Maternal and Child Health\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eNCD \u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..Non-Communicable Disease\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eSDG \u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..Sustainable Development Goal\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eWHO \u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.World Health Organization\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eEthical clearance was obtained from the Addis Ababa Public Health Research and Emergency Management Directorate. Permission letters were obtained from the Addis Ababa City Administration Health Bureau Institutional Review Board. All the study participants were reassured/informed that they would be anonymous. Access to the collected information was limited to the investigators, and confidentiality was maintained throughout the project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll relevant data are available upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Contribution\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eK.W. contributed to the study conception, designed the study, performed the statistical analysis, and drafted the manuscript. B.D. and F.M. assisted in the statistical analysis and drafting of the manuscript. All the authors revised and approved the final manuscript. K.W. contributed to the conception and proposal and writing of the research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all individuals involved in the facilitation of this research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eJalilian H, Heydari S, Mir N, Fehresti S, Khodayari-Zarnaq R. Forgone care in patients with type 2 diabetes: a cross-sectional study. BMC Public Health. 2021 Aug 24;21(1):1588.\u003c/li\u003e\n\u003cli\u003eR\u0026ouml;ttger J, Bl\u0026uuml;mel M, K\u0026ouml;ppen J, Busse R. Forgone care among chronically ill patients in Germany\u0026mdash;Results from a cross-sectional survey with 15,565 individuals. Health Policy [Internet]. 2016 Feb [cited 2022 Dec 22];120(2):170\u0026ndash;8. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0168851016000051\u003c/li\u003e\n\u003cli\u003eAnderson KE, McGinty EE, Presskreischer R, Barry CL. Reports of Forgone Medical Care Among US Adults During the Initial Phase of the COVID-19 Pandemic. JAMA Netw Open [Internet]. 2021 Jan 21 [cited 2023 Feb 6];4(1):e2034882. Available from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2775366\u003c/li\u003e\n\u003cli\u003eGlobal Health Expenditure Database [Internet]. [cited 2023 Feb 6]. Available from: https://apps.who.int/nha/database/\u003c/li\u003e\n\u003cli\u003eLi X, Chen M, Wang Z, Si L. Forgone care among middle aged and elderly with chronic diseases in China: evidence from the China Health and Retirement Longitudinal Study Baseline Survey. BMJ Open [Internet]. 2018 Mar [cited 2023 Feb 6];8(3):e019901. Available from: https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2017-019901\u003c/li\u003e\n\u003cli\u003eWHO. Noncommunicable diseases (NCD) country profiles. Risk of premature death due to NCDS in Ethiopia. [Internet]. 2018. Available from: https://scholar.google.com/scholar_lookup\u003c/li\u003e\n\u003cli\u003eGeldsetzer P, Manne-Goehler J, Marcus ME, Ebert C, Zhumadilov Z, Wesseh CS, et al. The state of hypertension care in 44 low-income and middle-income countries: a cross-sectional study of nationally representative individual-level data from 1\u0026middot;1 million adults. The Lancet [Internet]. 2019 Aug 24 [cited 2022 Dec 25];394(10199):652\u0026ndash;62. Available from: https://www.sciencedirect.com/science/article/pii/S0140673619309559\u003c/li\u003e\n\u003cli\u003eGuwatudde D, Nankya-Mutyoba J, Kalyesubula R, Laurence C, Adebamowo C, Ajayi I, et al. The burden of hypertension in sub-Saharan Africa: a four-country cross sectional study. BMC Public Health. 2015 Dec 5;15:1211.\u003c/li\u003e\n\u003cli\u003eTsuzaki K, Taira D. Forgone Health Care for Non\u0026ndash;COVID-19\u0026ndash;Related Needs Among Medicare Beneficiaries During the COVID-19 Pandemic, Summer 2020\u0026ndash;Winter 2021. Prev Chronic Dis [Internet]. 2022 Oct 13 [cited 2023 Feb 6];19:220110. Available from: http://www.cdc.gov/pcd/issues/2022/22_0110.htm\u003c/li\u003e\n\u003cli\u003eWHO. https://www.who.int/news-room/fact-sheets/detail/hypertension. 2021 Aug 25;\u003c/li\u003e\n\u003cli\u003eAverage Salary in Ethiopia 2023 - The Complete Guide [Internet]. [cited 2023 Nov 12]. Available from: https://www.salaryexplorer.com/average-salary-wage-comparison-ethiopia-c69?expand_article=1\u003c/li\u003e\n\u003cli\u003eAiny A, Idris H, Maharani A. Unmet Need for Healthcare Among People with Hypertension in Indonesia. 2020.\u003c/li\u003e\n\u003cli\u003eKuria N, Reid A, Owiti P, Tweya H, Kibet CK, Mbau L, et al. Compliance with follow-up and adherence to medication in hypertensive patients in an urban informal settlement in Kenya: comparison of three models of care. Trop Med Int Health TM IH. 2018 Jul;23(7):785\u0026ndash;94.\u003c/li\u003e\n\u003cli\u003eAdler AJ, Laar A, Prieto-Merino D, Der RMM, Mangortey D, Dirks R, et al. Can a nurse-led community-based model of hypertension care improve hypertension control in Ghana? Results from the ComHIP cohort study. BMJ Open. 2019 Apr 1;9(4):e026799.\u003c/li\u003e\n\u003cli\u003eLucevic A, P\u0026eacute;ntek M, Kringos D, Klazinga N, Gul\u0026aacute;csi L, Brito Fernandes \u0026Oacute;, et al. Unmet medical needs in ambulatory care in Hungary: forgone visits and medications from a representative population survey. Eur J Health Econ [Internet]. 2019 Jun [cited 2023 Jan 19];20(S1):71\u0026ndash;8. Available from: http://link.springer.com/10.1007/s10198-019-01063-0\u003c/li\u003e\n\u003cli\u003eThomas A, Valero-Elizondo J, Khera R, Warraich HJ, Reinhardt SW, Ali HJ, et al. Forgone Medical Care Associated With Increased Health Care Costs Among the U.S. Heart Failure Population. JACC Heart Fail. 2021 Oct;9(10):710\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eBonfrer I, Gustafsson-Wright E. Health shocks, coping strategies and foregone healthcare among agricultural households in Kenya. Glob Public Health. 2017 Nov 2;12(11):1369\u0026ndash;90.\u003c/li\u003e\n\u003cli\u003eBodenmann P, Favrat B, Wolff H, Guessous I, Panese F, Herzig L, et al. Screening Primary-Care Patients Forgoing Health Care for Economic Reasons. PLoS ONE. 2014 Apr 3;9(4):e94006.\u003c/li\u003e\n\u003cli\u003eWerner P, Tur-Sinai A. Prevalence and correlates of forgone care among adult Israeli Jews: A survey conducted during the COVID-19 outbreak. PloS One. 2021;16(11):e0260399.\u003c/li\u003e\n\u003cli\u003eForgone Health and Economic Benefits Associated with Socioeconomic Differences in Organized Cervical Cancer Screening - PMC [Internet]. 2023 [cited 2023 Feb 6]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7173370/\u003c/li\u003e\n\u003cli\u003eIlori HT, Adebusoye LA, Daramola OO, Ajetunmobi OA. Perceived family support and its effect on cardiovascular disease risk among hypertensive patients presenting at a family medicine practice in south west nigeria. Niger J Fam Pract. 2020;11(2):19\u0026ndash;26.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hypertension, Forgone care, Treatment withdrawal, Relinquished care","lastPublishedDoi":"10.21203/rs.3.rs-3954324/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3954324/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHypertension is a complex chronic disease requiring appropriate continuous medical care, and forgone care may exacerbate the severity of the disease and associated complications. The assessment of forgone care indicates the gap between perceived need and actual utilization of healthcare services. This study aimed to investigate the prevalence and associated factors affecting forgone care in patients with hypertension.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eA cross-sectional study was also conducted. Study subjects were selected by using a systematic sampling technique. The data were collected using an interview-administered written questionnaire. A descriptive analysis was conducted to obtain a summary value for each variable. All variables with a p value\u0026thinsp;\u0026lt;\u0026thinsp;0.25 in the bivariate analysis were entered into a multivariable logistic regression model to identify factors that were significantly associated with the outcome variable. A p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicated statistical significance. The data are presented in statements, tables, and graphs.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 405 patients were included in the study. Of these, 35.2% reported forgone care. The most frequently stated reason for forgoing care was the financial burden resulting from the costs of disease treatment (46.3%). According to the final multivariable regression model, the odds of receiving care among hypertensive patients who did not have community-based health insurance were 2.754 times greater than those among those who did. The odds of receiving care among hypertensive patients who did not have family support were 2.31 times greater than those among patients who had family support.\u003c/p\u003e\u003ch2\u003eConclusion and recommendation:\u003c/h2\u003e \u003cp\u003eA considerable number of patients with hypertension had a history of forgoing care, and the most important reasons for forgoing care were related to financial pressure and lack of family support for receiving treatment. A qualitative study is needed to further investigate the underlying reasons why hypertensive patients forgo healthcare.\u003c/p\u003e","manuscriptTitle":"Prevalence and associated factors of forgone care among hypertensive patients in selected public hospitals in Addis Ababa, Ethiopia: Cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-14 18:47:37","doi":"10.21203/rs.3.rs-3954324/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0cc9ed94-dc7c-4a12-af9e-c5391252b83e","owner":[],"postedDate":"February 14th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":28745405,"name":"Health Policy"}],"tags":[],"updatedAt":"2024-02-14T18:47:37+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-14 18:47:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3954324","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3954324","identity":"rs-3954324","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}