Socioeconomic status and hypertension

Leng, Bing; Jin, Yue; Li, Ge; Chen, Ling; Jin, Nan

doi:10.1097/hjh.0000000000000428

Cited by 436 publications

(394 citation statements)

References 65 publications

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“…22 The ∼1.5-fold risk we observed among those with a family history of hypertension and an inverse relationship between education level and hypertension risk also were in agreement with previous findings. 23 In addition, we found that low neighbourhood SES was associated with higher risk of hypertension, consistent with previously reported associations between neighbourhood deprivation characteristics such as poor walkability, availability of healthy foods, safety or social cohesion and hypertension risk. 17 The mechanisms by which low stress resilience may contribute to the development of hypertension are complex and likely involve both physiological and behavioural factors.…”

Section: Discussionsupporting

confidence: 91%

Low stress resilience in late adolescence and risk of hypertension in adulthood

Crump

Sundquist

Winkleby

et al. 2016

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Objective Greater blood pressure reactivity to psychological stress has been associated with higher risk of developing hypertension. We hypothesised that low stress resilience based on psychological assessment early in life is associated with hypertension in adulthood. Methods National cohort study of 1 547 182 military conscripts in Sweden during 1969–1997 (97–98% of all 18-year-old males) without prior history of hypertension, who underwent standardised psychological assessment by trained psychologists for stress resilience (1–9 scale), and were followed up for hypertension identified from outpatient and inpatient diagnoses during 1969–2012 (maximum age 62). Results 93 028 men were diagnosed with hypertension in 39.4 million person-years of follow-up. Adjusting for body mass index (BMI), family history and socioeconomic factors, low stress resilience at age 18 was associated with increased risk of hypertension in adulthood (lowest vs highest quintile: HR 1.43; 95% CI 1.40 to 1.46; p<0.001; incidence rates, 278.7 vs 180.0 per 100 000 person-years), including a strong linear trend across the full range of stress resilience (ptrend<0.0001). We also found a positive additive interaction between stress resilience and BMI (p<0.001), indicating that low stress resilience accounted for more hypertension cases among those with high BMI. Men with a combination of low stress resilience and high BMI had a more than threefold risk of hypertension. Conclusions These findings suggest that low stress resilience may contribute to etiological pathways for hypertension and accounts for more cases among those with high BMI. If confirmed, this knowledge may help inform better preventive interventions by addressing psychosocial risk factors and stress management across the lifespan.

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Section: Discussionsupporting

confidence: 91%

Low stress resilience in late adolescence and risk of hypertension in adulthood

Crump

Sundquist

Winkleby

et al. 2016

Heart

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“…The higher prevalence of hypertension presented among men is consistent with the general pattern observed in middle- and high-income regions and countries [3, 14, 15]. For example, prevalence of hypertension in Argentina (1988–2013) [29] was 34.5 % among men and 29.0 % among women, which was similar to findings from Cuba 2010–11 (34.1 % vs. 27.9 %) [30] and China 2009–10 (31.2 % vs. 28.0 %) [31]; also, men have a higher occurrence of this condition in Switzerland 1999–2009 (40.5 % vs. 28.3 %) [32] and England 2006 (32.9 % vs. 27.3 %) [33].…”

Section: Discussionsupporting

confidence: 86%

“…Overall, a variety of sociodemographic attributes, most prominently low education, male gender, and dark-skinned color, have been associated with hypertension [3, 14, 15]. However, epidemiologic evidence is scarce regarding the patterns of hypertension in emerging economies and about its relationship to multiple axes of social disadvantages.…”

Section: Introductionmentioning

confidence: 99%

Educational inequalities in hypertension: complex patterns in intersections with gender and race in Brazil

Alves

Faerstein

2016

Int J Equity Health

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BackgroundHypertension is a major public health issue worldwide, but knowledge is scarce about its patterns and its relationship to multiple axes of social disadvantages in Latin American countries. This study describes the educational inequality in the prevalence of hypertension in Brazil, including a joint stratification by gender and race.MethodsWe analyzed interview-based data and blood pressure measurements from 59,402 participants aged 18 years or older at the 2013 Brazilian National Health Survey (PNS). Sociodemographic characteristics analyzed were gender (male, female), racial self-identification (white, brown, black), age (5-years intervals), and educational attainment (pre-primary, primary, secondary, tertiary). Hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg, and/or self-reported use of antihypertensive medications in the last 2 weeks. We used logistic regression to evaluate the age-adjusted prevalences of hypertension (via marginal modeling), and pair-wise associations between education level and odds of hypertension. Further, the educational inequality in hypertension was summarized through the Relative Index of Inequality (RII) and the Slope Index of Inequality (SII). All analyses considered the appropriate sampling weights and intersections with gender, race, and education.ResultsAge-adjusted prevalence of hypertension was 34.0 % and 30.8 % among men and women, respectively. Black and brown women had a higher prevalence than whites (34.5 % vs. 31.8 % vs. 29.5 %), whereas no racial differences were observed among men. White and brown, but not black women, showed graded inverse associations between hypertension and educational attainment; among men, non-statistically significant associations were observed in all racial strata. The RII and SII estimated inverse gradients among white (RII = 2.5, SII = 18.1 %) and brown women (RII = 2.3, SII = 14.5 %), and homogeneous distributions of hypertension in educational subgroups among black women and among men.ConclusionIn this representative sample of Brazilian adults, the association between educational attainment and hypertension was influenced by gender and race – a topic still poorly understood. Our findings highlight the importance of assessing intersections of multiple sociodemographic characteristics in health inequalities research. The use of comprehensive measures of inequality, such as RII and SII, provide useful insights for monitoring health inequalities in an intersectional perspective.

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“…[8] In SA, a higher level of education has been found to predict lower values of both diastolic and systolic blood pressure in women, while higher income predicted lower systolic blood pressure. [9] Interestingly, this did not hold true for men.…”

Section: Researchmentioning

confidence: 96%

“…[4][5][6] The burden of ill-health and of chronic diseases such as hypertension is strongly influenced by socioeconomic status. [7][8][9] Few publications have considered the impact of socioeconomic status on control of blood pressure and potentially modifiable factors associated with better blood pressure control in SA.…”

Section: Researchmentioning

confidence: 99%

Socioeconomic and modifiable predictors of blood pressure control for hypertension in primary care attenders in the Western Cape, South Africa

et al. 2016

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Background. Low socioeconomic status is associated with the risk of hypertension. There are few reports of the effect of socioeconomic and potentially modifiable factors on the control of hypertension in South Africa (SA). Objectives. To investigate associations between patients' socio economic status and characteristics of primary healthcare facilities, and control and treatment of blood pressure in hypertensive patients. Methods. We enrolled hypertensive patients attending 38 public sector primary care clinics in the Western Cape, SA, in 2011, and followed them up 14 months later as part of a randomised controlled trial. Blood pressure was measured and prescriptions for antihypertension medications were recorded at baseline and follow-up. Logistic regression models assessed associations between patients' socioeconomic status, characteristics of primary healthcare facilities, and control and treatment of blood pressure. Results. Blood pressure was uncontrolled in 60% (1 917/3 220) of patients at baseline, which was less likely in patients with a higher level of education (p=0.001) and in English compared with Afrikaans respondents (p=0.033). Treatment was intensified in 48% (892/1 872) of patients with uncontrolled blood pressure at baseline, which was more likely in patients with higher blood pressure at baseline (p<0.001), concurrent diabetes (p=0.013), more education (p=0.020), and those who attended clinics offering off-site drug supply (p=0.009), with a doctor every day (p=0.004), or with more nurses (p<0.001). Conclusion. Patient and clinic factors influence blood pressure control and treatment in primary care clinics in SA. Potential modifiable factors include ensuring effective communication of health messages, providing convenient access to medications, and addressing staff shortages in primary care clinics.

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Socioeconomic status and hypertension

Cited by 436 publications

References 65 publications

Low stress resilience in late adolescence and risk of hypertension in adulthood

Low stress resilience in late adolescence and risk of hypertension in adulthood

Educational inequalities in hypertension: complex patterns in intersections with gender and race in Brazil

Socioeconomic and modifiable predictors of blood pressure control for hypertension in primary care attenders in the Western Cape, South Africa

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