Income, education, and blood pressure in adults in Jamaica, a middle-income developing country

Abstract

Social and cultural transitions during the process of economic development are thought to influence the pace at which hypertension and other risk factors for cardiovascular disease (CVD) emerge in developing countries. 1 Little is currently known about how socioeconomic factors may influence the distribution of blood pressure (BP) and hypertension in these societies, as few studies have been published, and results have been heterogeneous. [2][3][4][5] In contrast, there is a fairly consistent negative association between socioeconomic status (SES) and BP in industrialized countries. 2,6 This negative association is thought to have emerged between 1940 and 1960; earlier studies in the US and UK found that high SES groups were at greater risk. 6 The basis for the inconsistent associations between SES and BP in developing country studies is unclear. One explanation may be heterogeneity in stages of modernization and economic development. It has been hypothesized that there may be a transition in the relationship between SES and CVD risk, with the direction and magnitude of the associations changing from positive to negative with Westernization and economic development. 7,8 While there is limited-and conflicting-empirical Background At present, little is known about how socioeconomic status (SES) is related to blood pressure (BP) and hypertension in developing countries. This cross-sectional study examined associations between SES and BP in 2082 adults from a periurban area of Jamaica, a middle-income developing country.

Higher income is more strongly associated with obesity than with obesity-related metabolic disorders in Jamaican adults

“…In selected models, we also confirmed that an imputed income variable yielded similar findings to those presented (not shown). 30 In addition to imputed income, we confirmed that relationships were similar using family income data (Spearman's R with individual income ¼ 0.78) collected from a subgroup of 997 subjects as part of an earlier substudy. 33 The validity of income was further corroborated by a strong positive association with education: 62% of subjects with r6 years of education fell below the poverty line, while 69% of subjects with college education has incomes of J$6000 or more.…”

“…29 Associations between income and hypertension, including treatment and awareness, have been reported previously in greater detail. 30 Current income category in Jamaican dollars (pJ$600, 601-1000, 1001-3000, 3001-600, 6001-12000, Z12000) was obtained by self-report. Category midpoints were used to deflate income to 1993 Jamaican dollars based on data from the Statistical Institute of Jamaica.…”

“…As described previously, the distribution of hypertension was J-shaped: the top-income group tended to have the highest levels of hypertension, but levels were also elevated in the poorest men. 30 The distribution of diabetes was irregular, although levels were highest in the top-income group. After adjustment, income associations with both diabetes and hypertension were weak and nonsignificant.…”

Gender differences in prevalence and socioeconomic determinants of hypertension: findings from the WHO STEPs survey in a rural community of Vietnam

“…The rich men and the poor women had a higher risk of being hypertensive than people of the same gender in the average living standard group. This is supported by a Jamaican study 43 and may imply a diverse range of factors associated with hypertension in particular and cardiovascular diseases in general. High risks of hypertension among the rich men of Bavi may reflect the adoption of Western lifestyle such as high-fat diet, smoking, alcohol consumption and office stress, etc.…”

Urbanization and Inequality in Hypertension Diagnosis and Medication in Indonesia

“…Whereas, Gulliford, Mahabir, and Bocke (2004) find a negative association of systolic blood pressure with increasing income in women in Trinidad and Tobago. Mendez et al (2003) report for the case of adults in Jamaica that raised blood pressure levels were elevated both in low-as well as high-income groups. For the case of Indonesia, Witoelarm, Strauss, and Sikoki (2009) were unable to detect a significant relation between schooling history and hypertension.…”