Objective  To study the status and influencing factors of medication among middle-aged and elderly hypertension patients in Shaanxi province and to explore the contributions of the factors influencing the medication inequality in the patients.

  Methods  The data on 5 774 hypertension patients aged ≥ 45 years were derived from the Fifth National Health Services Survey conducted in 2013 among 20 700 households recruited with stratified random sampling in 32 counties/districts across Shaanxi province. Ordinal logistic regression was used to explore influencing factors of medication among the patients. Concentration index (CI) was employed to assess medication inequality and decomposition of CI was adopted to evaluate the contributions of influencing factors of medication inequality among the patients.

  Results  The prevalence rate of hypertension was 20.50% among the ≥ 45 years old participants of the survey in 2013. Of all the hypertension patients identified in the survey, 58.46% reported regular medication recommended by doctors. Ordinal logistic regression analysis demonstrated that residential region, age, marital status, education, employment, medical insurance, economic condition, alcohol drinking, physical exercise, and self-rated health were significant influencing factors of hypertension medication (P < 0.05 for all). The CI of medication was 0.015 62 for all the hypertension patients; the correlates with higher contribution to medication inequality were economic condition (positive percentage of contribution to CI: 49.71%), medical insurance (21.26%), residential region (18.54%), and 11.17% and all the correlates increased the pro-rich inequality of hypertension medication.

  Conclusion  The proportion of regular medication was low and there was a pro-rich medication inequality among middle-aged and elderly hypertension patients in Shaanxi province; improvement in economic condition, medical insurance and education could reduce the medication inequality in the hypertension patients.