Educational inequality in physician-diagnosed hypertension widened and persisted among women from 1999 to 2014 in Hong Kong

Gary K K Chung,Eng-Kiong Yeoh,Francisco T T Lai,Roger Y Chung

doi:10.1038/s41598-019-50760-6

Gary K K Chung, Eng-Kiong Yeoh + Show 2 more

Open Access

https://doi.org/10.1038/s41598-019-50760-6

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Abstract

Gender differences in the trend of educational inequality in hypertension have been observed especially in the Asian populations, indicating the increasing importance of education as a social determinant of hypertension among women. This study examined the gender-specific trends of educational inequality in physician-diagnosed hypertension in Hong Kong between 1999 and 2014. Based on a series of eight government-led territory-wide household surveys conducted between 1999 and 2014, 97,481 community-dwelling Hong Kong Chinese adults aged 45 or above were analysed. The extent and trend of gender-specific educational inequality in self-reported physician-diagnosed hypertension were estimated by regression-based Relative Index of Inequality and age-standardised Slope Index of Inequality. Over the study period, age-standardised prevalence of self-reported hypertension increased in both genders, with the greatest prevalence among the least educated women. Educational inequalities in hypertension significantly widened in female from 1999 to 2009 and persisted thereafter; nonetheless, the respective inequality was negligible in male. Further adjustment for household income did not attenuate the observed inequality. To conclude, a widened and then persistent discrepancy in hypertension across education levels was observed among women, but not among men, in Hong Kong. The gender perspective should be carefully considered when designing hypertension prevention strategies and related health policies.

Highlights

Hypertension has long been recognized as a dominant preventable risk factor of numerous non-communicable diseases, especially cardiovascular and cerebrovascular diseases[1], and as the single leading cause of global disease burden[2]
After further adjustments for household income level, the extent of educational inequality did not significantly attenuate, and the overall patterns remained unchanged (Supplementary Table S4). This is the first study to examine gender-specific trends of educational inequality in physician-diagnosed hypertension over the recent two decades using a series of population-representative surveys in Hong Kong
In addition to the overall rising trend in both genders, our study revealed that the surge in hypertension among the less educated women was substantially higher than that for their more educated counterparts between 1999 and 2009, leading to a widening educational inequality in hypertension, in both relative and absolute terms, in female during the period

Summary

Introduction

Hypertension has long been recognized as a dominant preventable risk factor of numerous non-communicable diseases, especially cardiovascular and cerebrovascular diseases[1], and as the single leading cause of global disease burden[2]. Education has long been considered the most important socioeconomic indicator of hypertension[4]. While widening or persistent trends of educational inequality in hypertension and other cardiovascular risk factors have been well-documented in the Western populations over the past decades[9,10,11], less relevant studies could be found in Asian settings for comparison. No studies in developed Asian setting, to our best knowledge, have investigated the trends of educational inequality in hypertension over the past two decades. It is hypothesized that the inequality in hypertension across education levels would have widened over time, and more apparently among women

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Conclusion