Influence of contextual socioeconomic position on hypertension risk in low- and middle-income countries: disentangling context from composition

Abstract

Background Hypertension has emerged as the single most significant modifiable risk factor for cardiovascular disease and death worldwide. Resource-limited settings are currently experiencing the epidemiological transition from infectious diseases to chronic non-communicable diseases, primarily due to modifications in diet and lifestyle behaviour. The objective of this study was to examine the influence of individual-, community- and country-level factors associated with hypertension in low- and middle-income countries (LMICs). Methods Multivariable multi-level logistic regression analysis was applied using 12 Demographic and Health Survey (DHS) datasets collected between 2011 and 2018 in LMICs. We included 888,925 respondents (Level 1) nested within 33,883 neighbourhoods (Level 2) from 12 LMICs (Level 3). Results The prevalence of hypertension ranged from 10.3% in the Kyrgyz Republic to 52.2% in Haiti. After adjusting for the individual-, neighbourhood- and country-level factors, we found respondents living in the least deprived areas were 14% more likely to have hypertension than those from the most deprived areas (OR = 1.14, 95% CI 1.10 to 1.17). We observed a significant variation in the odds of hypertension across the countries and the neighbourhoods. Approximately 26.3 and 47.6% of the variance in the odds of hypertension could be attributed to country- and neighbourhood-level factors, respectively. We also observed that respondents moving to a different neighbourhood or country with a higher risk of hypertension had an increased chance of developing hypertension, the median increase in their odds of hypertension was 2.83-fold (95% CI 2.62 to 3.07) and 4.04- fold (95% CI 3.98 to 4.08), respectively. Conclusions This study revealed that individual compositional and contextual measures of socioeconomic status were independently associated with the risk of developing hypertension. Therefore, prevention strategies should be implemented at the individual level and the socioeconomic and contextual levels to reduce the burden of hypertension.

Association between gender-based violence and hypertension among women in the Kyrgyzstan Republic

“…DHS wealth index was used as a proxy indicator for the socio-economic position. Thus, wealth status was categorised into poorest, poorer, middle, richer and richest categories [ 18 ].…”

Obesity and hypertension: Obesity medicine association (OMA) clinical practice statement (CPS) 2023

“…Like obesity, lower socio-economic status is associated with higher rates of hypertension, especially among those with lower levels of education [ 132 ], and even within races [ 129 , 133 ]. Beyond lower education, factors that may contribute to higher blood pressure among socio-economically disadvantaged individuals include disparities resulting in less healthful nutrition (i.e., increased saturated fats and sodium) [ 134 , 135 ], less access to healthful nutrition (i.e., cost, food desserts) [ 136 ], lack of fruits and vegetables, less physical activity, more alcohol consumption, increased smoking, higher rates of dyslipidemia, increased psychosocial stress, discrimination, malnutrition in early childhood, poverty at older age, increased air pollution, reduced employment status, higher comorbid health conditions, and limitations to quality health care [ 133 , 137 ].…”

Socioeconomic Macro-Level Determinants of Hypertension: Ecological Analysis of 138 Low- and Middle-Income Countries

“…High blood pressure is a preventable disease associated directly with lifestyle habits, including an unhealthy diet, physical inactivity and tobacco smoking [ 8 ]. The relationship between high blood pressure, income level, wealth, employment status and place of residence has been identified in the literature [ 9 , 10 , 11 ]. Other individual-level factors such as ethnicity, education level, and unhealthy behaviours have received much attention [ 12 , 13 ].…”