Spatiotemporal Variation of the Association between Urbanicity and Incident Hypertension among Chinese Adults

Abstract

Urbanization is believed to result in a transition towards energy-dense diets, sedentary lifestyles, and a subsequent increase in the burden of hypertension (HTN) and other cardiovascular diseases (CVDs) in developing countries. However, the extent to which this occurs is likely dependent on social contexts. We performed multilevel logistic regression models to examine whether the association between incident HTN and the degree to which a community exhibits urban features varied by region (the Northeast, East Coast, Central, and West) within China and period. We used longitudinal data from the China Health and Nutrition Survey (1991–2015) and stratified analyses by sex. Among women, the positive association between medium-to-high urbanicity and HTN onset generally shifted to negative between 1991 and 2015. The high urbanicity was associated with lower odds of developing HTN in the East Coast from the early 1990s. The negative association between high urbanicity and HTN occurrence became statistically significant during 1991–2015 in the Northeastern and Central Regions, while the association remained positive and non-significant in the West. Among men, the relationship between urbanicity and incident HTN was generally non-significant, except for the East Coast in which the negative association between high urbanicity and HTN occurrence became statistically-significant in more recent years. Our findings suggest that, when a subnational region or the society as a whole has become more economically developed, higher urbanicity might turn out to be a protective factor of cardiovascular health. Moreover, improvements made to communities’ urban features might be more effective in preventing HTN for women than for men.

Thirty-Year Urbanization Trajectories and Obesity in Modernizing China

“…Abdominal adiposity in China was found to be positively associated with urbanization in the 1990s and changed to a negative association in the 2000s [ 1 ]. Another study indicated that the association of urbanization with hypertension was also not linear, which meant higher urbanization, to some extent, might turn out to be a protective factor [ 2 ]. Changes in early urabanizing stage on community food environment, such as increasing availability of restaurants and supermarkts, as well as community norms for fast food consumption [ 38 ], may be one of the explanations for the obesity challenge.…”

“…Since the population residing in urban areas is increasing rapidly worldwide, the influence of urban features on health has greater importance [ 1 , 2 ]. Urbanization is defined as urban population size or density and usually explores the association of health by an urban–rural dichotomy [ 3 , 4 ].…”

Determinants of Prevalence and Stages of Undiagnosed Hypertension

“…For example, a systematic review found that urbanization was strongly associated with increased HTN prevalence, a phenomenon attributed to more sedentary lifestyles and high-sodium diets in urban areas (26) . Additionally, urban areas like Metropolitan Lima are often associated with higher stress levels, environmental pollution, and more industrialized food options, known risk factors for this disease (4,27) .…”

“…For example, a systematic review found that urbanization was strongly associated with increased HTN prevalence, a phenomenon attributed to more sedentary lifestyles and high-sodium diets in urban areas (26) . Additionally, urban areas like Metropolitan Lima are often associated with higher stress levels, environmental pollution, and more industrialized food options, known risk factors for this disease (4,27) . The observed relationship between a higher wealth index and a lower prevalence of HTN, precisely stage III HTN, is consistent with the literature suggesting that better socioeconomic status can offer protection against more severe forms of HTN.…”