Hypertension and Socioeconomic Status in South Central Uganda: A Population-Based Cohort Study

Abstract

Background: Limited studies exploring the impact of socioeconomic status (SES) on hypertension in Africa suggest a positive association between higher SES and hypertension. The economic development in sub-Saharan African countries has led to changes in SES and associated changes in lifestyle, diet, and physical activity, which may affect the relationship between hypertension and SES differently compared with higher income countries. This cross-sectional study from a large populationbased cohort, the Rakai Community Cohort Study (RCCS), examines SES, hypertension prevalence, and associated risk factors in the rural Rakai Region in south-central Uganda.Methods: Adults aged 30-49 years residing in 41 RCCS fishing, trading, and agrarian communities, were surveyed with biometric data obtained between 2016 and 2018. The primary outcome was hypertension (systolic blood pressure (BP) ≥ 130 mmHg or diastolic BP ≥ 80 mmHg). Modified Poisson regression assessed the adjusted prevalence ratios (PR) of hypertension associated with SES; body mass index (BMI) was explored as a potential mediator.Results: Among 9,654 adults, 20.8% had hypertension (males 21.2%; females 20.4 %). Participants with hypertension were older (39.0 ± 6.0 vs. 37.8 ± 5.0; p < 0.001). Higher SES was associated with overweight or obese BMI categories (p < 0.001). In the multivariable model, hypertension was associated with the highest SES category (aPR 1.23; confidence interval 1.09-1.38; p = 0.001), older age, male sex, alcohol use, and living in fishing communities and inversely associated with smoking and positive HIV serostatus. When BMI was included in the model, there was no association between SES and hypertension (aPR 1.02; CI 0.90-1.15, p = 0.76). Conclusion:Hypertension is common in rural Uganda among individuals with higher SES and appears to be mediated by BMI. Targeted interventions could focus on lifestyle modification among highest-risk groups to optimize public health impact. 2 Mustapha et al.

Overweight and obesity in south central Uganda: A population-based study

“…In this study, the probability of being overweight or obese increased with SES, similar to past research in Uganda [13,36,37], sub-Saharan Africa [3,24,25,38] and low-and middleincome countries [39]. This trend differs from that of high-income countries where the prevalence of overweight and obesity decreases with wealth [40].…”

Mediating effect of BMI on the association of economic status and coexistence of hypertension and diabetes in Bangladesh: A counterfactual framework‐based weighting approach

“…A study in the Korean population also found a similar directional association 53 . More studies focused on the independent association between ES and hypertension and diabetes separately, especially in developing countries, and reported a positive association 34,54–57 . Obesity rates have risen with urbanization and gross domestic product growth, accompanied by shifts in diet and reduced activity.…”

Cardiovascular (Framingham) and type II diabetes (Finnish Diabetes) risk scores: a qualitative study of local knowledge of diet, physical activity and body measurements in rural Rakai, Uganda

“…The prevalence of raised fasting glucose including diabetes was 3.3%, and close to 90% of participants who were found to have a raised fasting glucose were not on medication nor aware of their hyperglycaemia [9]. The prevalence of hypertension among adults in our study population is estimated at 20.8% [10].…”